Provider Demographics
NPI:1669442497
Name:PERELMAN, ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:PERELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 PARK ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-1846
Mailing Address - Country:US
Mailing Address - Phone:651-225-1102
Mailing Address - Fax:651-225-2988
Practice Address - Street 1:590 PARK ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1846
Practice Address - Country:US
Practice Address - Phone:651-225-1102
Practice Address - Fax:651-225-2988
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43338174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN001637300Medicaid
MN250000525Medicare ID - Type Unspecified
MNH49513Medicare UPIN