Provider Demographics
NPI:1588760144
Name:PETRAS, VERA (MD)
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:PETRAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 RIVERBOAT CENTER DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-9341
Mailing Address - Country:US
Mailing Address - Phone:815-942-2932
Mailing Address - Fax:815-942-3154
Practice Address - Street 1:1541 RIVERBOAT CENTER DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-9341
Practice Address - Country:US
Practice Address - Phone:815-942-2932
Practice Address - Fax:815-942-3154
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360535132085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053513-003Medicaid
IL036053513-003Medicaid