Provider Demographics
NPI:1538478094
Name:MICHAEL G. PERERA M.D., INC.
Entity Type:Organization
Organization Name:MICHAEL G. PERERA M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:PERERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-445-1853
Mailing Address - Street 1:612 W. DUARTE RD. #702
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-9245
Mailing Address - Country:US
Mailing Address - Phone:626-445-1853
Mailing Address - Fax:626-445-8627
Practice Address - Street 1:612 W. DUARTE RD. #702
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9245
Practice Address - Country:US
Practice Address - Phone:626-445-1853
Practice Address - Fax:626-445-8627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26063207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A24704Medicare UPIN