Provider Demographics
NPI:1467558510
Name:PERILMAN, STEVEN KYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:KYLE
Last Name:PERILMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STEVEN
Other - Middle Name:KYLE
Other - Last Name:PERILMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:3533 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-694-5000
Practice Address - Fax:361-694-5317
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4430207PP0204X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10022295OtherAMERIGROUP PIN
TX121320100OtherFIRSTCARE PIN
TX137345805Medicaid
TX5040636OtherAETNA PIN
TX134992007Medicaid
TX134992008Medicaid
TX1854186OtherFIRSTHEALTH PIN
TX108867OtherSUPERIOR PIN
TX88629XOtherBCBSTX IND PIN
TX00L42VOtherBCBSTX GRP PIN
TX1415257OtherUHC PIN
1669442042OtherGRP NPI NUMBER
TX4731603OtherCIGNA PIN
TX137283103Medicaid
G15191Medicare UPIN
TX137345805Medicaid
TX00L42VMedicare PIN