Channing Petrak
MD | Pediatrics | Female
Channing Petrak, MD is a Peoria, Illinois based Pediatric doctor with medical specialization in
General Pediatrics.
Current practice location of Channing Petrak is
Dept Of Pediatrics, 320 E Armstrong, Peoria, Illinois - 61603. She can be contacted on phone at
309-624-9587.
Channing Petrak is a sole proprietor of her business.
NPI number (Unique professional ID) for Channing Petrak is
1952370538 which was assigned by NPPES on 16 Mar, 2006 and it was last updated on 22 Jul, 2013.
Channing Petrak license number is
036108511 for Pediatrics (208000000X) in Illinois.
Channing Petrak is a pediatrician who is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Complete Profile:
Channing Petrak basic information including her official name, gender, specialization, credentials etc. are as mentioned below.
| Specialization : | Pediatrics |
|---|
| Provider Name : | Channing Petrak |
|---|
| Credential : | MD |
|---|
| Gender : | Female |
|---|
Business Address:
Channing Petrak address, contact phone number and fax are as below. Patients can directly walkin to the clinic or can call on the below given phone number for appointment.
| Primary Address : | Dept Of Pediatrics, 320 E Armstrong
Peoria, IL, 61603
United States |
|---|
| Phone Number : | 309-624-9587 |
|---|
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). NPI details are as mentioned below.
| NPI Number : | 1952370538 |
|---|
| NPI Entity Type : | Individual |
|---|
| First Enrolment Date : | 16 Mar, 2006 |
|---|
| Last Updated On : | 22 Jul, 2013 |
|---|
Licenses and Specialities:
Physicians/Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Channing Petrak are as mentioned. Primary taxonomy code for Channing Petrak, MD is
208000000X (Pediatrics).
| Taxonomy Code | Speciality | Primary | License No. | State |
|---|
| 208000000X | Pediatrics | Yes | 036108511 | IL |
Legacy Identifiers:
Other legacy medical identifiers of Channing Petrak such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned below.
| Identifier | Identifier Type | State | Issuer |
|---|
| 07215036 | Other | IL | BCBS |
| 639810 | Other | IL | MEDICARE PTAN |
| IL01CN | Other | IL | JOHN DEERE |
| 036108511 | MEDICAID | IL | |
Mailing Address:
Mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned business address only.
| Mailing Address : | 1 Illini Dr
Peoria, IL, 61605-2576
United States |
|---|
| Phone Number : | 309-671-8503 |
|---|
Business Location:
Patients can refer following map for directions to
Channing Petrak practice address. Don't forget to take prior appointment before visiting.
** Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 January, 2024.