MARK PETROCELLI (NPI# 1033344171) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033344171 |
| Entity Type | Individual |
| Full Name | MARK PETROCELLI |
| Credential | D.O. |
| Practice Address |
940 River Centre Dr Port Huron MI 48060-4463 |
| Practice Telephone | 8109854900 |
| Practice Fax Number | 8109853634 |
| Mailing Telephone | 8109854900 |
| Mailing Fax Number | 8109853634 |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2018-11-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | 5101018133 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
940 RIVER CENTRE DR |
| City | PORT HURON |
| State | MI |
| Zip Code | 48060-4463 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376544593 | Steven J Heithoff | Orthopaedic Surgery | 940 River Centre Dr, Port Huron, MI 48060-4463 | 2005-08-10 |
| 1285116202 | Kelsay Kristine Payton | Physician Assistant | 940 River Centre Dr, Port Huron, MI 48060 | 2018-09-06 |
| 1275079758 | Ashley Stevenson | Physical Therapist | 940 River Centre Dr, Port Huron, MI 48060-4463 | 2017-01-09 |
| 1093265225 | Ashley Lauren Turner | Physician Assistant | 940 River Centre Dr, Port Huron, MI 48060-4463 | 2016-10-12 |
| 1346612447 | Amanda Whymer | Nurse Practitioner | 940 River Centre Dr, Port Huron, MI 48060-4463 | 2015-10-28 |
| 1528440203 | Shelby Conard | Specialist/Technologist | 940 River Centre Dr, Port Huron, MI 48060-4463 | 2015-06-18 |
| 1144628009 | Orthopedic Associates of Port Huron, PC | Radiology | 940 River Centre Dr, Port Huron, MI 48060-4463 | 2014-12-09 |
| 1023433158 | Joshua Bosley Kiba | Physician Assistant | 940 River Centre Dr, Port Huron, MI 48060-4463 | 2014-02-26 |
| 1104103928 | Laura Ann Kinsley | Physical Therapist | 940 River Centre Dr, Port Huron, MI 48060-4463 | 2011-11-08 |
| 1992008759 | Kathryn Cpak | Physician Assistant | 940 River Centre Dr, Port Huron, MI 48060-4463 | 2010-12-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740897297 | Casey Edward Bicker | Behavior Technician | 3245 Keewahdin Rd; Fort Gratiot, Mi 48059, Port Huron, MI 48060 | 2020-09-29 |
| 1962032078 | Brianne Salchert | Peer Specialist | 1170 Michigan Rd., Port Huron, MI 48060 | 2020-01-17 |
| 1982123006 | Kenneth Shine Heuvelman | Counselor | 3522 Holland Park Ln, Port Huron, MI 48060 | 2017-09-11 |
| 1346767506 | Kelly Baker | Social Worker | 520 Superior St., Port Huron, MI 48060 | 2017-08-28 |
| 1326418609 | Jean Burleigh | Chore Provider | 614 Staton, Port Huron, MI 48060 | 2015-09-30 |
| 1205242161 | Lisa Gray | Counselor | 2885 W Rick Dr, Port Huron, MI 48060 | 2014-07-10 |
| 1861758880 | Aaron Overly | Surgery | 2609 Electric Ave Ste B&, Port Huron, MI 48060 | 2012-04-03 |
| 1942591508 | S Akram Ali | Surgery | 3270 Waldheim Dr, Port Huron, MI 48060 | 2011-04-29 |
| 1417258179 | Nicholas Alexander Tobianski | Physician Assistant | 3550 Pine Grove Avenue, Port Huron, MI 48060 | 2010-11-11 |
| 1598092769 | Blue Water Pharmacy LLC | Pharmacy | 1524 10th Street, Port Huron, MI 48060 | 2009-11-10 |
| Find all providers in zip 48060 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215991732 | Edward J Nebel | Orthopaedic Surgery | 2615 Electric Ave, Suite A, Port Huron, MI 48060-6587 | 2006-04-13 |
| 1821068594 | Gerald Jerry | Orthopaedic Surgery | 600 Fort St, Suite 100, Port Huron, MI 48060-3941 | 2006-01-25 |
| 1184175812 | Jerry Orthopaedic Institute, Pllc | Orthopaedic Surgery | 600 Fort St, Suite 100, Port Huron, MI 48060-3941 | 2016-10-18 |
| 1255783858 | Zieger Orthopaedics Pllc | Orthopaedic Surgery | 600 Fort St, Suite 100, Port Huron, MI 48060-3941 | 2016-07-07 |
| 1386998011 | Advanced Orthopedics Orthotics LLC | Orthopaedic Surgery | 1231 Pine Grove Ave Ste 1a, Port Huron, MI 48060-3500 | 2012-11-02 |
| 1073844841 | Edward J Nebel, M.d. PC | Orthopaedic Surgery | 2615 Electric Ave, Suite A, Port Huron, MI 48060-6575 | 2010-01-19 |
| 1649409020 | William Mckenna Braaksma | Orthopaedic Surgery | 940 River Centre Dr, Port Huron, MI 48060-4463 | 2009-07-07 |
| 1285817700 | Bone & Joint Institute P C | Orthopaedic Surgery | 600 Fort St, Suite 100, Port Huron, MI 48060-3941 | 2007-12-06 |
| 1790814986 | Advanced Orthopedic Pllc | Orthopaedic Surgery | 1231 Pine Grove Ave, Suite 1a, Port Huron, MI 48060-3500 | 2007-03-05 |
| 1558396721 | Bone & Joint Institute, P.C. | Orthopaedic Surgery | 600 Fort St, Suite 100, Port Huron, MI 48060-3941 | 2006-07-12 |
| Find all providers in PORT HURON | ||||
| City | PORT HURON |
| Zip Code | 48060 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.