Petrak, Russell M
Petrak, Russell M is an individual health care provider with primary practice located at 901 Mcclintock Dr Suite 201, Burr Ridge IL 60527-0872. He recently has only one registered license in Allopathic & Osteopathic Physicians / Infectious Disease, which is considered as his primary health care specialty. Petrak, Russell M can be contacted via phone (888) 220-6432.Contact Information
Primary practice address
901 Mcclintock Dr Suite 201
Burr Ridge IL 60527-0872
Phone: (888) 220-6432
Fax: (630) 654-4253
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Infectious Disease | 207RI0200X | 036-063551 | Illinois |
Profile Details
| NPI number | 1376539692 |
|---|---|
| LBN Legal business name | Petrak, Russell M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 22nd, 2005 |
| Last updated | Dec 16th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376539692 | NPPES |
| Indiana | MEDICAID | 200856780 | |
| Indiana | MEDICAID | 036-063-551 | |
| Indiana | Other | Z158638 | |
| Indiana | MEDICAID | 0420281 |
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