Provider Demographics
NPI:1588669188
Name:PETROVICH, ALISON (MD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:PETROVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:GLENDENING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-392-7084
Mailing Address - Fax:219-703-6854
Practice Address - Street 1:10215 BROADWAY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8001
Practice Address - Country:US
Practice Address - Phone:219-661-6152
Practice Address - Fax:219-703-6833
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054379207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200345670Medicaid
IN000000721923OtherANTHEM TRADITIONAL
INM400050578Medicare PIN
IN000000721923OtherANTHEM TRADITIONAL
IN202790CCMedicare PIN