CHANNING PETRAK (NPI# 1952370538) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952370538 |
| Entity Type | Individual |
| Full Name | CHANNING PETRAK |
| Credential | MD |
| Practice Address |
Dept of Pediatrics 320 E Armstrong Peoria IL 61603 |
| Mailing Address |
1 Illini Dr Peoria IL 61605-2576 |
| Practice Telephone | 3096249587 |
| Mailing Telephone | 3096718503 |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2013-07-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 036108511 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS | 07215036 | 01 |
| IL | MEDICARE PTAN | 639810 | 01 |
| IL | 036108511 | 05 | |
| IL | JOHN DEERE | IL01CN | 01 |
| Street Address |
DEPT OF PEDIATRICS 320 E ARMSTRONG |
| City | PEORIA |
| State | IL |
| Zip Code | 61603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659336030 | Umesh Chatrath | Pediatrics | Dept of Pediatrics, 320 E Armstrong, Peoria, IL 61603 | 2006-04-19 |
| 1356319479 | Heather Mclauchlan | Pediatrics | Dept of Pediatrics, 320 E Armstrong, Peoria, IL 61603 | 2006-03-14 |
| 1508834839 | Lourdes Delgado-serrano | Psychiatry & Neurology | Dept of Pediatrics, 320 E Armstrong, Peoria, IL 61603 | 2006-03-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598362980 | Courtney Klein | Nurse Practitioner | 1306 N. Berkley Ave, Peoria, IL 61603 | 2020-10-08 |
| 1114588217 | Kong Xing Wang | Dentist | 320 East Armstrong Ave, Peoria, IL 61603 | 2019-06-28 |
| 1073015319 | Sara Kristine Rosenbery | Nurse Practitioner | 515 Ne Glen Oak Ave Ste 202, Peoria, IL 61603 | 2018-03-02 |
| 1861860058 | Jennifer Michelle Kelsey | Clinical Nurse Specialist | 420 Ne Glen Oak Avenue, Suite 401, Peoria, IL 61603 | 2015-09-04 |
| 1467859793 | Bonnie Lansing | Counselor | 617 N Gendale Avenue, Behavioral Health Adult Program, Peoria, IL 61603 | 2014-12-02 |
| 1639597172 | Jael K. Mahasi | Counselor | 1800 Ne Perry Avenue, Peoria, IL 61603 | 2014-04-02 |
| 1992054829 | Justin S Ferragut | Radiology | 530 Northeast Glen Oak Avenue, Peoria, IL 61603 | 2012-09-06 |
| 1780952994 | Syed Muhammad Tayyab | Internal Medicine | 828 Ne Glen Oak Ave Apt No208a, Peoria, IL 61603 | 2011-12-02 |
| 1528389079 | St. Francis Medical Center | General Acute Care Hospital | 530 N E Glen Oak Ave, Peoria, IL 61603 | 2010-06-18 |
| 1780810648 | Children's Home Association of Illinois | Voluntary or Charitable | 400 E. Frye, Peoria, IL 61603 | 2009-06-05 |
| Find all providers in zip 61603 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780200865 | Kuang Chuen Liu | Pediatrics | 530 Ne Glen Oak Ave, Peoria, Peoria, IL 61637 | 2020-06-24 |
| 1578186839 | Katie Michelle Stapleton | Pediatrics | Osf St Francis Medical Center 530 Ne Glen Oak Avenue, Peoria, IL 61637-0001 | 2020-05-21 |
| 1760042162 | Paulette Padilla | Pediatrics | 3128 N Linnhill Ct, Peoria, IL 61604-1650 | 2019-06-18 |
| 1942799465 | Khaled Faisal Abdul Rahman | Pediatrics | 530 Ne Glen Oak Ave Bldg 5th, Peoria, IL 61637-0001 | 2018-05-10 |
| 1356859128 | Pleasant Pediatrics Plc | Pediatrics | 10204 W Happy Valley Rd Ste 165, Peoria, AZ 85383-2880 | 2018-01-16 |
| 1427408863 | Josef Newman | Pediatrics | 5654 N Building, 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2016-06-16 |
| 1962856054 | Brittany Nichole Vaio | Pediatrics | 9059 W Lake Pleasant Pkwy Suite E-540, Peoria, AZ 85382 | 2016-04-15 |
| 1790025591 | Pleasant Pediatrics Plc | Pediatrics | 9744 W Northern Ave, Suite 1310, Peoria, AZ 85345-4603 | 2013-02-15 |
| 1629365424 | May C Sun | Pediatrics | 2401 W Alta Rd Apt 905, Peoria, IL 61615-1290 | 2011-06-30 |
| 1205064003 | Sandhya Chaudhari | Pediatrics | 530 Ne Glran Oak Ave, Peoria, IL 61637-0001 | 2009-06-30 |
| Find all providers in PEORIA | ||||
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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.