Doctor Name: | MARTIN MICHAEL PETITH |
NPI Number: | 1780773457 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | |
Business Practice Address: | 2401 W Main St Va Medical Center Marion, IL - 629591188 |
Business Phone Number: | 6189975311 |
Business Fax Number: | 6189985696 |
Mailing Address: | 902 S Johnson Ave, CARBONDALE |
State: | IL |
Postal Code: | 629012468 |
Phone Number: | 6185499266 |
Fax Number: | |
NPI Enumeration Date: | 10/12/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
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. |