Provider Demographics
NPI:1518046713
Name:PEROVICH, ROBERT MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:PEROVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MS
Other - First Name:JACQUIE
Other - Middle Name:
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2855 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-1405
Mailing Address - Country:US
Mailing Address - Phone:954-346-9404
Mailing Address - Fax:954-344-8460
Practice Address - Street 1:2855 N UNIVERSITY DR
Practice Address - Street 2:SUITE 500
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-1405
Practice Address - Country:US
Practice Address - Phone:954-346-9404
Practice Address - Fax:954-344-8460
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME640162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL189982Medicare ID - Type Unspecified
E40739Medicare UPIN