Free National NPI Number Registry
Mr. Edward K Petrusch
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NPI Number Detailed Information
Provider Information:
| Name: | Mr. Edward K Petrusch |
| Gender: | M |
| Provider License Number If Given: | 820A |
NPI Information:
| NPI: | 1386647337 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 5/23/2005 |
| Last Update Date: | 4/11/2013 |
Provider Business Mailing Address:
| Address: | 444 COLLETT BRIDGE RD Alvaton, KY 42122 |
| Phone Number: | 2708420433 |
| Fax Number: |
Provider Business Practice Location Address:
| Address: | 444 COLLETT BRIDGE RD Alvaton, KY 42122 |
| Phone Number: | 2708420433 |
| Fax Number: |
Provider Taxonomy:
| Primary: | 367500000X |
| Secondary (if any): | |
| State: | KY |
