Provider Demographics
NPI:1073578902
Name:PERRY, ERIC SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:SCOTT
Last Name:PERRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6932
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-6932
Mailing Address - Country:US
Mailing Address - Phone:734-212-3097
Mailing Address - Fax:
Practice Address - Street 1:37000 WOODWARD AVE SUITE 350
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0944
Practice Address - Country:US
Practice Address - Phone:248-952-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011115207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11285787OtherCAQH
MIF76861Medicare UPIN
MIP00080724Medicare PIN