Provider Demographics
NPI:1235270067
Name:PERLMUTTER, ADAM ERIC (DO)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:ERIC
Last Name:PERLMUTTER
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 1:707 CEDAR ST STE 405
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2059
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1919 LAKE AVE STE 104
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-7830
Practice Address - Country:US
Practice Address - Phone:574-948-5390
Practice Address - Fax:574-948-5473
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2040208800000X
NY244682208800000X
IN02003333A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200905870Medicaid
NY02883416Medicaid
IN000000570239OtherANTHEM
IN000000570239OtherANTHEM
IN252000NMedicare PIN