Provider Demographics
NPI:1730151846
Name:PETRUS, JOHN J (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:PETRUS
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:PO BOX 74589
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-4589
Mailing Address - Country:US
Mailing Address - Phone:330-461-9300
Mailing Address - Fax:
Practice Address - Street 1:3347 REVERE RD
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44286-9705
Practice Address - Country:US
Practice Address - Phone:330-461-9300
Practice Address - Fax:330-867-1195
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-2725207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0303081Medicaid
OH0303081Medicaid
OH0667414Medicare PIN
OHE50032Medicare UPIN