National Provider Identifier Database

PETRUNGARO PLASTIC SURGERY LLC
Plastic and Reconstructive Surgery


Contact Information

PETRUNGARO PLASTIC SURGERY, LLC
800 MACARTHUR BLVD STE 21
MUNSTER, IN46321-2918
Phone: 219-836-1163
Fax:
Website:
Specialty Taxonomy Code
* Plastic and Reconstructive Surgery 2086S0122X

* Indicates primary specialty

NPI Profile & details for PETRUNGARO PLASTIC SURGERY, LLC

NPI Number 1639577794
Legal business name
LBN
PETRUNGARO PLASTIC SURGERY, LLC
Authorized official JASON PETRUNGARO - (PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 12/05/2014
Last updated 05/08/2015 - About 11 years ago
Sole proprietor1 Not specified
Identifiers
  • IN License #: 01074460A
  • IN Other: 9183790 AETNA
  • IN Other: 914915 BCBS
  • IN Other: 5410211 CIGNA

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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