Provider Demographics
NPI:1376576975
Name:PERENCEVIC, BORIS M (MD)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:M
Last Name:PERENCEVIC
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:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:1702 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-364-3300
Practice Address - Fax:701-364-8906
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8983207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND61G43PEOtherMNBS #
ND11876Medicaid
ND142045OtherUCARE #
ND2002346OtherMEDICA #
ND22005OtherNDBS #
ND1631609OtherAMERICA'S PPO/ARAZ #
ND2001170OtherMEDICA #
NDDA9011029846OtherPREFERRED ONE #
NDHP38336OtherHEALTHPARTNERS #
NDND200234OtherLHS #
NDND200234OtherLHS #
ND2002346OtherMEDICA #
NDH37500Medicare UPIN