Provider Demographics
NPI:1124196886
Name:PERRELLI, KARA J (MD)
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:J
Last Name:PERRELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:J
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17310 WRIGHT ST STE 103
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2405
Mailing Address - Country:US
Mailing Address - Phone:833-228-6889
Mailing Address - Fax:877-853-0376
Practice Address - Street 1:17310 WRIGHT ST STE 103
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2405
Practice Address - Country:US
Practice Address - Phone:833-228-6889
Practice Address - Fax:877-853-0376
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
MEEC-05-1692085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1124196886Medicaid
MD126696ZBQ0Medicare PIN
VA1124196886Medicaid
VAP01073489Medicare PIN
VAVV5944AMedicare PIN
MDP01068601Medicare PIN