Provider Demographics
NPI:1649229758
Name:PERZANOWSKI-OBREGON, CHRISTIAN A (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:A
Last Name:PERZANOWSKI-OBREGON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:A
Other - Last Name:PERZANOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:635 EICHENFELD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5908
Mailing Address - Country:US
Mailing Address - Phone:813-684-6000
Mailing Address - Fax:813-654-9032
Practice Address - Street 1:635 EICHENFELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5908
Practice Address - Country:US
Practice Address - Phone:813-684-6000
Practice Address - Fax:813-654-9032
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 95425207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2023073OtherMEDICARE
FLU7703YMedicare PIN
I169793Medicare UPIN