Petro, Lacie
Petro, Lacie is an individual health care provider with primary practice located at 1302 Franklin Ave Ste 1100 , Normal IL 61761-0016. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Petro, Lacie can be contacted via phone (309) 268-5620.Contact Information
Primary practice address
1302 Franklin Ave Ste 1100
Normal IL 61761-0016
Phone: (309) 268-5620
Fax: (309) 661-6226
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 125-050112 | Illinois |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 036119502 | Illinois |
Profile Details
| NPI number | 1619189859 |
|---|---|
| LBN Legal business name | Petro, Lacie |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 3rd, 2007 |
| Last updated | Feb 12th, 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 | 1619189859 | NPPES |
| Illinois | Other | 833120 | MEDICARE GROUP PTAN |
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