Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JEREMY BRADFORD PETROUS, DO
ActiveSports Medicine (IM) · GRAND RAPIDS, MI
Registration Details
- NPI Number
- 1639584196
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jun 24, 2014 (11.825576825857 yrs)
- Last Updated
- Feb 25, 2021
- Licenses
-
5101021240 (MI)5101021240 (MI)
Practice Information
- Address
-
4100 LAKE DR SE STE 200GRAND RAPIDS, MI, 49546Browse MI providers · Browse ZIP 49546
- Phone
- 6163913759
- Primary Specialty
-
Sports Medicine (IM)
207RS0012X
- Additional Specialty
- Sports Medicine (IM)
Other Sports Medicine (IM) Providers in GRAND RAPIDS, MI
| Name | Credential | NPI |
|---|---|---|
| DR. JASON PATRICK COLES | MD | 1619088580 |
| DR. SOUMYA CHOWDARY MADALA | M.D. | 1043334527 |
| DR. RAVICHAND MADALA | M.D. | 1083730907 |
| DAVID CHI MING SHEN | MD | 1114120771 |
| DR. KELLY ANNE WATERS | M.D. | 1821232455 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.