Provider Demographics
NPI:1134360167
Name:PEREZ CARTAGENA, PEDRO ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:ANTONIO
Last Name:PEREZ CARTAGENA
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 1:1201 MICHIGAN AVE
Mailing Address - Street 2:SUITE 70
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1580
Mailing Address - Country:US
Mailing Address - Phone:574-753-1730
Mailing Address - Fax:
Practice Address - Street 1:30S CAYUGA RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5443
Practice Address - Country:US
Practice Address - Phone:716-632-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-22
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064949A207L00000X, 208VP0000X
ND13604207L00000X
NY252166207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001046163OtherANTHEM
IN201374680Medicaid
INP01693410OtherRAILROAD MEDICARE
IN000001046163OtherANTHEM