Provider Demographics
NPI:1184835126
Name:PERLSTEIN, LAIS UNGARI (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:LAIS
Middle Name:UNGARI
Last Name:PERLSTEIN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5655
Mailing Address - Country:US
Mailing Address - Phone:617-549-0853
Mailing Address - Fax:
Practice Address - Street 1:1705 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6920
Practice Address - Country:US
Practice Address - Phone:480-964-2273
Practice Address - Fax:480-718-9477
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228041207R00000X
AZ46622207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110085029AMedicaid
AZ864565Medicaid