Provider Demographics
NPI:1649243676
Name:PERLSON, JOEL A (DO)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:A
Last Name:PERLSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15777 NORTHLINE RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2354
Practice Address - Country:US
Practice Address - Phone:734-246-8100
Practice Address - Fax:313-581-0228
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006866208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3078099Medicaid
MI0Q260790OtherBCBSM
MI010049845OtherPALMETTO
MI010049845OtherPALMETTO
MIE359816Medicare UPIN
MI3078099Medicaid
MI010049845Medicare PIN