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Provider Information for 1609213016

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. JOHN PETRILLI M.D.

Gender: MALE

Individual NPI: 1609213016

Calendar   Last Updated:  2020-09-11
  Certification Date:  2020-09-11

Details

Name Value
NPI 1609213016
Enumeration Date 2013-05-24
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address PO BOX 917770
ORLANDO, FL 32891-0001
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 13330 USF LAUREL DR
TAMPA, FL 33612-6601
United States

Phone: 813-974-2201 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other BLUE CROSS BLUE SHIELD FL L8J51
MEDICAID FL 016722000
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207Q00000X - Family Medicine FL ME120968