Provider Demographics
NPI:1033283544
Name:PEREZ, HERMINIO L (MD)
Entity Type:Individual
Prefix:DR
First Name:HERMINIO
Middle Name:L
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:2825 LIVERNOIS
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083
Mailing Address - Country:US
Mailing Address - Phone:248-680-6000
Mailing Address - Fax:248-680-6068
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:2825 LIVERNOIS
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083
Practice Address - Country:US
Practice Address - Phone:248-680-6000
Practice Address - Fax:248-680-6068
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI430150172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI442933010Medicaid
080H262390OtherBLUE CROSS-BLUE CROSS
HP050172OtherCOMMERCIAL-COMMERCIAL NUMBER
HP050172OtherCHAMPUS-CHAMPUS
080H262390OtherBLUE CROSS-BLUE CROSS
0H26239151Medicare ID - Type Unspecified