MARVIN W. PETRY M.D., NPI 1467493627 — CHICAGO (IL)

NPI 1467493627

13+ Years Experience Individual

MARVIN W. PETRY M.D.

06.09.2006
PROVIDER ENUMERATION DATE
07.08.2007
LAST UPDATE DATE
1467493627
NPI NUMBER

About MARVIN W. PETRY

MARVIN W. PETRY is a provider established in CHICAGO, IL. The NPI number of MARVIN W. PETRY is 1467493627 and was assigned on 06.09.2006. The practitioners primary taxonomy code is: 2085R0202X IL .

Mailing address

  • City: CHICAGO
  • State: IL
  • Postal code: 606074001
  • Phone: 3128292523
  • Address: 901 S ASHLAND AVE

Primary Practice Address

  • Region : CHICAGO, IL
  • NPI : 1467493627
  • Phone : 3128646000
  • Postalcode : 606123714
  • Address : 1901 W HARRISON ST JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY

Provider taxonomy - Radiology

  • Taxonomy code: 2085R0202X
  • License state: IL

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Contacts:

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  • MARVIN W. PETRY M.D.
  • Address : 1901 W HARRISON ST JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY
  • Region : CHICAGO, IL
  • NPI : 1467493627
  • Phone : 3128646000
  • Postalcode : 606123714

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address1901 W HARRISON ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCHICAGO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameIL
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code606123714
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number3128646000
The telephone number associated with the location address of the provider being identified.
NPI1467493627
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 12085R0202X
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Provider Enumeration Date06.09.2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07.08.2007
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)MARVIN W. PETRY
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address901 S ASHLAND AVE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameCHICAGO
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameIL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code606074001
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number3128292523
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Healthcare Provider Taxonomy Code #12085R0202X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Provider License Number State Code 1IL
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorX
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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