Provider Demographics
NPI:1033125992
Name:PEARLMAN, RALPH DONALD (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:DONALD
Last Name:PEARLMAN
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 1:22250 PROVIDENCE DR
Mailing Address - Street 2:STE #702
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-557-9650
Mailing Address - Fax:248-557-5033
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:STE #702
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-557-9650
Practice Address - Fax:248-557-5033
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRP045454208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3194561Medicaid
MI3194561Medicaid
MI06305015281Medicare ID - Type Unspecified