| Doctor Name: | DR. LOUIS ALFRED PETRUCCO |
| NPI Number: | 1770704454 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 5315026105 |
| Business Practice Address: | 29310 East River Road Grosse Ile, MI - 481381955 |
| Business Phone Number: | 7346767868 |
| Business Fax Number: | |
| Mailing Address: | 29310 East River Road, GROSSE ILE |
| State: | MI |
| Postal Code: | 481381955 |
| Phone Number: | 7346767868 |
| Fax Number: | |
| NPI Enumeration Date: | 05/01/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RA0201X |
| License Number: | 5315026105 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Allergy & Immunology |
| Taxonomy Definition: | An internist doctor of osteopathy that specializes in the treatment of allergy and immunologic disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Special Qualifications in the field of Allergy & Immunology. |