Provider Demographics
NPI:1497779219
Name:SCHALL, PERRY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:MICHAEL
Last Name:SCHALL
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 1:45280 SEELEY DR
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-6834
Mailing Address - Country:US
Mailing Address - Phone:760-610-7300
Mailing Address - Fax:760-610-7301
Practice Address - Street 1:45280 SEELEY DR FL 3
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-6834
Practice Address - Country:US
Practice Address - Phone:760-610-7300
Practice Address - Fax:760-610-7301
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC146193207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0596485Medicaid
OHA15956Medicare UPIN
OH0596485Medicaid