Provider Demographics
NPI:1437368479
Name:PERNI, PRAVEEN C (MD)
Entity Type:Individual
Prefix:
First Name:PRAVEEN
Middle Name:C
Last Name:PERNI
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 1:12174 N MERIDIAN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4578
Mailing Address - Country:US
Mailing Address - Phone:317-208-3866
Mailing Address - Fax:317-208-3867
Practice Address - Street 1:12174 N MERIDIAN ST STE 100
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4578
Practice Address - Country:US
Practice Address - Phone:317-208-3866
Practice Address - Fax:317-208-3867
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067826A207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200996340Medicaid
IN151560007Medicare PIN
IN151560007Medicare PIN