Provider Demographics
NPI:1972505105
Name:PETRACEK, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:PETRACEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 HARDING RD
Mailing Address - Street 2:STE 450
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-6048
Mailing Address - Country:US
Mailing Address - Phone:615-385-4781
Mailing Address - Fax:615-383-4366
Practice Address - Street 1:4230 HARDING RD
Practice Address - Street 2:STE 450
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-6048
Practice Address - Country:US
Practice Address - Phone:615-385-4781
Practice Address - Fax:615-383-4366
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD013206208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3945508008OtherCIGNA HMO
TN3740031OtherUNITED HEALTHCARE
TN2000298OtherBCBS OF TENNESSEE
TN4066885OtherAETNA PPO
TN0995598OtherAETNA HMO
TN3009775Medicaid
TN3945508007OtherCIGNA PPO
TNA97408Medicare UPIN
TN3945508007OtherCIGNA PPO