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Gregory J Pettaway II, MD
Emergency Medicine Physician in South Bend, Indiana
NPI 1851701841

Gregory J Pettaway II is a Emergency Medicine Physician based in South Bend, IN. Gregory J Pettaway II practices in South Bend, IN and has the professional credentials of MD. The NPI Number for Gregory J Pettaway II is 1851701841 and holds a License No. (Indiana).

The current practice location address for Gregory J Pettaway II is 615 N Michigan St, South Bend, IN and can be reached out via phone at 574-647-1000.

Location: 615 N Michigan St, South Bend, IN, 46601-1033
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1851701841
Provider Name
Gregory J Pettaway II
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
615 N Michigan St, South Bend, IN, 46601-1033
Phone Number
574-647-1000
Fax Number
Provider Enumeration Date
04/30/2014
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
300001115 05 IN
941030008 01 IN MEDICARE PTAN
institution
Provider Business Practice Location Address Details
Address
615 N Michigan St
City
South Bend
State
Indiana
Zip
46601-1033
Phone Number
574-647-1000
Fax Number
person
Provider Business Mailing Address Details
Address
615 N Michigan St
City
South Bend
State
Indiana
Zip
46601-1033
Phone Number
574-647-1000
Fax Number
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Emergency Medicine
Speciality
-
Taxonomy
207P00000X
License No.
01078046A (Indiana)
Definition
An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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