Basic Information
| Provider Information | |||||||||
| NPI: | 1972505105 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETRACEK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4230 HARDING RD | ||||||||
| Address2: | STE 450 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372056048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153854781 | ||||||||
| FaxNumber: | 6153834366 | ||||||||
| Practice Location | |||||||||
| Address1: | 4230 HARDING RD | ||||||||
| Address2: | STE 450 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372056048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153854781 | ||||||||
| FaxNumber: | 6153834366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 05/04/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | MD013206 | TN | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 3945508008 | 01 | TN | CIGNA HMO | OTHER | 3740031 | 01 | TN | UNITED HEALTHCARE | OTHER | 2000298 | 01 | TN | BCBS OF TENNESSEE | OTHER | 4066885 | 01 | TN | AETNA PPO | OTHER | 0995598 | 01 | TN | AETNA HMO | OTHER | 3009775 | 05 | TN | MEDICAID | 3945508007 | 01 | TN | CIGNA PPO | OTHER |