NPIMap

Individual provider Active NPI

Michael Petry, M.D.

  • Diagnostic Radiology Physician
  • Duluth, MN
National Provider Identifier
1942731583
Registry record updated Sep 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
71698 Issued in MN
Practice address
400 E 3Rd St
Duluth, MN 55805-1951
Phone
(218) 786-8364
NPI assigned
Mar 24, 2017
Last updated
Sep 30, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 71698 MN Primary

Addresses

Primary practice location

400 E 3Rd St
Duluth, MN 55805-1951

Mailing address

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221014001063 MN Practitioner - Diagnostic Radiology 3870972763 Reassigns benefits to 1 organization
I20230306000508 WI Practitioner - Diagnostic Radiology 3870972763 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, shared by 25 NPIs, 1,135 clinicians

Practice addresses (Care Compare)

1101 9TH St N
Virginia, MN 55792-2329
Phone (218) 741-0150

1615 Maple LN
Suite 1
Ashland, WI 54806-3630
Phone (715) 685-7500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary's Hospital of Superior Current Accepting new patients
St. Mary's Duluth Clinic Health System Current Accepting new patients
The Duluth Clinic, LTD CurrentSince Jan 14, 2023 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Sep 26, 2022 Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
St Mary's Hospital of Superior CurrentSince Feb 1, 2023 Accepting new patients
The Duluth Clinic, LTD CurrentSince Sep 26, 2022 Accepting new patients
St. Mary's Hospital of Superior CurrentSince Feb 1, 2023 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients

Locations

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

420 E 1st St
Duluth, MN 55805
Phone (218) 786-1265

1101 9th St N
Virginia, MN 55792
Phone (218) 305-0000

603 9th St N
Virginia, MN 55792
Phone (218) 741-3013

1615 Maple Ln
Ste 1
Ashland, WI 54806
Phone (715) 685-7500

11134 N State Road 77
Hayward, WI 54843
Phone (715) 634-5505

15495 County Road B
Hayward, WI 54843
Phone (715) 634-2641

3500 Tower Ave
Superior, WI 54880
Phone (715) 392-8281

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1490313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664496000000",
    "number": "1942731583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRY",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-24",
        "last_updated": "2022-09-30",
        "certification_date": "2022-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "71698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.