Basic Information
| Provider Information | |||||||||
| NPI: | 1881701282 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETRO | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | BERKAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4111 W MITCHELL ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532151748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143858800 | ||||||||
| FaxNumber: | 4146718860 | ||||||||
| Practice Location | |||||||||
| Address1: | 4111 W MITCHELL ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532151748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143858800 | ||||||||
| FaxNumber: | 4146718860 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 22492 | WI | N | Allopathic & Osteopathic Physicians | Surgery | 2083X0100X | 22492-20 | WI | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | AP8894013 | 01 | DEA NUMBER | OTHER | 30511300 | 05 | WI | MEDICAID |