Kathy M Petteruti, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

5101007608 Issued in MI

Practice address

13355 E 10 Mile Rd
Suite 229
Warren, MI 48089-2048

Phone

(586) 758-6263

Fax

(586) 758-7725

NPI assigned

Jul 25, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528081213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13355 E 10 MILE RD",
            "address_2": "SUITE 229",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480892048",
            "telephone_number": "586-758-6263",
            "fax_number": "586-758-7725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13355 E 10 MILE RD",
            "address_2": "SUITE 229",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480892048",
            "telephone_number": "586-758-6263",
            "fax_number": "586-758-7725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTERUTI",
        "first_name": "KATHY",
        "middle_name": "M",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101007608",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1425614",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carolyn B Peters, CRNA
• Jolonda Janae Peters, LLMSW
• Ryan James Peters
• Sonia Amirali Pethani, BPT
• Ugishia Pettaway
• Victoria Lynne Pettey
• PG Home Care Inc
• PGF Behavorial Services
• Juliann Pham
• Pharmacure RX LLC

• Internal Medicine Physician in Warren, MI
• Providers in Warren, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.