Provider Demographics
NPI:1164618302
Name:PERLIK, BROOKE MICHELLE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:MICHELLE
Last Name:PERLIK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34600 CHARDON RD UNIT 7
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-8481
Mailing Address - Country:US
Mailing Address - Phone:440-602-6737
Mailing Address - Fax:440-942-0316
Practice Address - Street 1:34600 CHARDON RD UNIT 7
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-8481
Practice Address - Country:US
Practice Address - Phone:440-602-6737
Practice Address - Fax:440-942-0316
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002657363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0071233Medicaid
OH0071233Medicaid