DR. JOHN PETROVICH (NPI# 1083162416) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083162416 |
| Entity Type | Individual |
| Full Name | DR. JOHN PETROVICH |
| Credential | M.D. |
| Practice Address |
1034 S Brentwood Blvd Suite 450a Saint Louis MO 63117-1223 |
| Mailing Address |
29 Flower Hill Ct Saint Louis MO 63122-1913 |
| Practice Telephone | 3143764845 |
| Mailing Telephone | 3145801923 |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2016-09-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 036073474 | IL | Other Service Providers |
| Street Address |
1034 S BRENTWOOD BLVD SUITE 450A |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63117-1223 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720082233 | Levi S Kirkland Jr. | Surgery | 1034 S Brentwood Blvd, Suite 694, Saint Louis, MO 63117-1223 | 2005-06-13 |
| 1770028953 | Christina Cammon | Nurse Practitioner | 1034 S Brentwood Blvd, Suite 516, Saint Louis, MO 63117-1223 | 2016-12-27 |
| 1396289468 | Natalie Beth Antin | Social Worker | 1034 S Brentwood Blvd, Suite 555, Saint Louis, MO 63117-1223 | 2016-12-08 |
| 1417490772 | Patrick Alan Behnke | Nurse Practitioner | 1034 S Brentwood Blvd, Suite 600, Saint Louis, MO 63117-1223 | 2016-11-18 |
| 1457803611 | St Louis Trauma Counseling LLC | Social Worker | 1034 S Brentwood Blvd, Suite 555, Saint Louis, MO 63117-1223 | 2016-11-03 |
| 1912459439 | 360 Health Care, LLC | In Home Supportive Care | 1034 S Brentwood Blvd, Suite 450a, Saint Louis, MO 63117-1223 | 2016-11-01 |
| 1609320076 | Allyson Graves | Speech-Language Pathologist | 1034 S Brentwood Blvd, #300, Saint Louis, MO 63117-1223 | 2016-08-15 |
| 1609237718 | Christine Shore-fitzgerald | Social Worker | 1034 S Brentwood Blvd, Suite 555, Saint Louis, MO 63117-1223 | 2016-03-16 |
| 1164883518 | St. Louis Dbt, LLC | Social Worker | 1034 S Brentwood Blvd, Suite 555, Saint Louis, MO 63117-1223 | 2016-03-13 |
| 1689032708 | Home Doctors Medical Associates | Family Medicine | 1034 S Brentwood Blvd, Suite 450, Saint Louis, MO 63117-1223 | 2016-02-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255956611 | Efehi Kelly Ogbomo | Student in an Organized Health Care Education/Training Program | 6420 Clayton Rd, Suite 2218, St. Louis, MO 63117 | 2020-06-11 |
| 1619533890 | Abdul Rauf | Student in an Organized Health Care Education/Training Program | 6420 Clayton Road. Ssm Health St. Mary's Hospital, St. Louis, MO 63117 | 2019-05-14 |
| 1083278477 | Mohamed Maali Gumaa Mohamed | Student in an Organized Health Care Education/Training Program | 6420 Clayton Road Ssm St. Mary's Hospital, Department of Internal Medicine, St. Louis, MO 63117 | 2019-05-01 |
| 1750945556 | Samrat Jun Jayanth | Student in an Organized Health Care Education/Training Program | 6420 Clayton Road, Ssm Health St Mary's Hospital, St. Louis, MO 63117 | 2019-04-26 |
| 1215491329 | Latonya Allen | Counselor | 1612 S. Big Bend Blvd, St. Louis, MO 63117 | 2019-01-23 |
| 1265917025 | Blue Stars Therapy, LLC | Occupational Therapist | 1101 Edward Terrace, Apt A, St. Louis, MO 63117 | 2018-09-27 |
| 1770060014 | Ultra Care Home Services LLC | Home Health | 7353 Dale Ave, Saint Louis, MO 63117 | 2018-07-19 |
| 1235623562 | Melissa Valerie Taylor | Counselor | Psychological Services of St Louis, LLC, 7110 Oakland Ave, St Louis, MO 63117 | 2018-06-20 |
| 1124517289 | Jideofor Ebony Obodozie | Student in an Organized Health Care Education/Training Program | 6420 Clayton Road, Ssm St. Mary's Hospital, St. Louis, MO 63117 | 2018-05-04 |
| 1770071706 | Sivaram Prabhuji Muppaneni | Student in an Organized Health Care Education/Training Program | Ssm St Mary's Hospital, 6420 Clayton Road, St. Louis, MO 63117 | 2018-04-25 |
| Find all providers in zip 63117 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| 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. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497381990 | Styles 40 Salon | Specialist | 4550 Gravois Ave, Saint Louis, MO 63116-2426 | 2020-03-16 |
| 1013560721 | Against The Grainz | Specialist | 8523 Drury Ln, Saint Louis, MO 63147-1313 | 2019-07-22 |
| 1487211033 | Kia Lanay Lewis | Specialist | 9700 Portage Dr, Saint Louis, MO 63136-5312 | 2019-05-20 |
| 1376011007 | Lashonda S Wash | Specialist | 222 Bruce Ave, Saint Louis, MO 63135-2704 | 2018-11-12 |
| 1326516048 | Showna Walker | Specialist | 2242 Berwyn Dr, Saint Louis, MO 63136-5415 | 2018-11-12 |
| 1760973697 | Angela Haas | Specialist | 1361 Childress Ave, Saint Louis, MO 63139-3451 | 2018-05-26 |
| 1962907782 | Kelsey Conley | Specialist | 2839 Howard St, Saint Louis, MO 63106-2027 | 2018-03-25 |
| 1285135848 | Che Salon | Specialist | 8416 Olive Blvd, Saint Louis, MO 63132-2816 | 2018-02-27 |
| 1790225084 | Michael Bergman | Specialist | 6327 S Grand Blvd, Apt 1g, Saint Louis, MO 63111-2653 | 2017-03-06 |
| 1275082406 | Tim Fick | Specialist | 5157 Lemay Ferry Rd, Saint Louis, MO 63129-1533 | 2016-09-29 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63117 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.