Petrak, Channing

Petrak, Channing is an individual health care provider with primary practice located at Dept Of Pediatrics 320 E Armstrong, Peoria IL 61603. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Petrak, Channing can be contacted via phone (309) 624-9587.

Contact Information

Primary practice address
Dept Of Pediatrics 320 E Armstrong Peoria IL 61603
Phone: (309) 624-9587
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 036108511 Illinois

Profile Details

NPI number 1952370538
LBN Legal business name Petrak, Channing
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 16th, 2006
Last updated Jul 22nd, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952370538 NPPES
Illinois MEDICAID 036108511
Illinois Other 639810
Illinois Other 07215036
Illinois Other IL01CN

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