DR. LYUDMILA IVANOVNA PETRUK MD NPI 1528154770

NPI Information

NPI: 1528154770
Provider Name: DR. LYUDMILA IVANOVNA PETRUK, MD
Classification: Neuromusculoskeletal Medicine, Sports Medicine - 204C00000X
Entity Type: Individual
Organization: CARSON TAHOE PHYSICIAN CLINICS

PECOS Registration: Yes

Address:
209 MARTIN LUTHER KING JR WAY
TACOMA, WA
ZIP 98405
Phone: (253) 596-3410
Get Directions

DR. Lyudmila Ivanovna Petruk, MD is a neuromusculoskeletal medicine sports medicine in Tacoma, WA with 22 years of experience. The provider is definition to come. DR. Lyudmila Ivanovna Petruk, MD NPI is 1528154770. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE
Graduation Year:2002

The provider's business location address is:

209 MARTIN LUTHER KING JR WAY
TACOMA, WA
ZIP 98405-265
Phone: (253) 596-3410

The NPI 1528154770 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/5/2006 and was last updated on 6/10/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	204C00000X	Neuromusculoskeletal Medicine, Sports Medicine		MD27033	OREGON	No
2	204C00000X	Neuromusculoskeletal Medicine, Sports Medicine		MD00046499	WASHINGTON	Yes
3	2084N0400X	Psychiatry & Neurology	Neurology	21092	NEVADA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	8543415	MEDICAID	WASHINGTON
2	MD27033	OTHER	OREGON	MEDICAL LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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