Provider Demographics
NPI:1659404333
Name:PERSKY, MICHAEL A (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:PERSKY
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16311 VENTURA BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2124
Mailing Address - Country:US
Mailing Address - Phone:818-501-3223
Mailing Address - Fax:818-981-7031
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2124
Practice Address - Country:US
Practice Address - Phone:818-501-3223
Practice Address - Fax:818-981-7031
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG44996207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AP1242798Medicare UPIN