Provider Demographics
NPI:1487612297
Name:PETRATOS, PETER BILL (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:BILL
Last Name:PETRATOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MARTIN AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6535
Mailing Address - Country:US
Mailing Address - Phone:630-355-5633
Mailing Address - Fax:630-355-5215
Practice Address - Street 1:10 MARTIN AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6535
Practice Address - Country:US
Practice Address - Phone:630-355-5633
Practice Address - Fax:630-355-5215
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1118932086S0127X
IL036111893208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I23369Medicare UPIN