Ivan Petrich, DO

NPI 1639527096 · on the registry since 2016

Practice

Address: 90 Hope Dr
Mountain Home Afb, ID 83648
Phone: (208) 828-7900
Organisation at this address: Mt Home Refill Phcy
366th Medical Group Sgsl
366th Medgrp-Mountain Home
366th Medgrp-Mountain Home
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 90

Registry record

Primary taxonomy: 207Q00000X
207Q00000X
Also registered as: 2083A0100X
Licence states on file: NC
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2025-09-12

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Idaho