Provider Demographics
NPI:1346243060
Name:PERACHA, MOHAMMAD HANIF (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:HANIF
Last Name:PERACHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 N. MONROE ST.
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2936
Mailing Address - Country:US
Mailing Address - Phone:734-242-2727
Mailing Address - Fax:734-242-2745
Practice Address - Street 1:725 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2936
Practice Address - Country:US
Practice Address - Phone:734-242-2727
Practice Address - Fax:734-242-2745
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB42971174400000X
MIMP031547207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101372510Medicaid
MI101372510Medicaid
MIB42971Medicare UPIN