Provider Demographics
NPI:1518066760
Name:PERLMAN, BARON (PH D)
Entity Type:Individual
Prefix:DR
First Name:BARON
Middle Name:
Last Name:PERLMAN
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 PARK ST
Mailing Address - Street 2:PO BOX 1230
Mailing Address - City:WAUTOMA
Mailing Address - State:WI
Mailing Address - Zip Code:54982-9031
Mailing Address - Country:US
Mailing Address - Phone:920-787-6550
Mailing Address - Fax:920-787-0421
Practice Address - Street 1:230 PARK ST
Practice Address - Street 2:
Practice Address - City:WAUTOMA
Practice Address - State:WI
Practice Address - Zip Code:54982-9031
Practice Address - Country:US
Practice Address - Phone:920-787-6550
Practice Address - Fax:920-787-0421
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI599103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39009200Medicaid
WI88692Medicare ID - Type UnspecifiedMEDICARE