Provider Demographics
NPI:1710987557
Name:ROBERT M PEROVICH MD PA
Entity Type:Organization
Organization Name:ROBERT M PEROVICH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PEROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-346-9404
Mailing Address - Street 1:3111 N UNIVERSITY DR
Mailing Address - Street 2:STE 400
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5086
Mailing Address - Country:US
Mailing Address - Phone:954-346-9404
Mailing Address - Fax:954-344-8460
Practice Address - Street 1:3111 N UNIVERSITY DR
Practice Address - Street 2:STE 400
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5086
Practice Address - Country:US
Practice Address - Phone:954-346-9404
Practice Address - Fax:954-344-8460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME640162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1517Medicare ID - Type Unspecified
E40739Medicare UPIN