Provider Demographics
NPI:1437458072
Name:PERRON, TINA MICHELLE (DPM)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:MICHELLE
Last Name:PERRON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13295 ILLINOIS ST SUITE 104
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:INDIANA
Mailing Address - Zip Code:46032
Mailing Address - Country:UM
Mailing Address - Phone:317-218-4095
Mailing Address - Fax:317-733-3041
Practice Address - Street 1:13295 ILLINOIS ST STE 104
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3025
Practice Address - Country:US
Practice Address - Phone:317-218-4095
Practice Address - Fax:317-733-3041
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN07001173A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program