| Doctor Name: | DR. DAVID A PETRUSKA |
| NPI Number: | 1104979590 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 24702 |
| Business Practice Address: | 927 45th St Suite 204 West Palm Beach, FL - 334072450 |
| Business Phone Number: | 5618826214 |
| Business Fax Number: | 5618826216 |
| Mailing Address: | 4521 Pga Blvd, Suite 105 PALM BEACH GARDENS |
| State: | FL |
| Postal Code: | 334183997 |
| Phone Number: | 5618826214 |
| Fax Number: | 5618826216 |
| NPI Enumeration Date: | 01/19/2007 |
| NPI Last Update Date: | 04/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 24702 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KY |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |