Provider Demographics
NPI:1114140167
Name:RALPH D PEARLMAN MD PC
Entity Type:Organization
Organization Name:RALPH D PEARLMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-557-9650
Mailing Address - Street 1:22250 PROVIDENCE DR STE 702
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-6215
Mailing Address - Country:US
Mailing Address - Phone:248-557-9650
Mailing Address - Fax:248-557-5033
Practice Address - Street 1:22250 PROVIDENCE DR STE 702
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-6215
Practice Address - Country:US
Practice Address - Phone:248-557-9650
Practice Address - Fax:248-557-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRP045454208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3194561Medicaid
MI=========OtherFEDERAL TAX ID
MI=========OtherFEDERAL TAX ID
MI3194561Medicaid