Provider Demographics
NPI:1407808140
Name:PERLMUTTER, MICHAEL JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JEFFREY
Last Name:PERLMUTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1300 W LEXINGTON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1154
Mailing Address - Country:US
Mailing Address - Phone:859-901-9907
Mailing Address - Fax:859-901-9904
Practice Address - Street 1:1300 W LEXINGTON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1154
Practice Address - Country:US
Practice Address - Phone:859-901-9907
Practice Address - Fax:859-901-9904
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY38695207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64081359Medicaid
KY1954501Medicare ID - Type Unspecified
A62501Medicare UPIN