Provider Demographics
NPI:1205981586
Name:PERRO, MICHELLE DOMINIQUE (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DOMINIQUE
Last Name:PERRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 S ELISEO DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2011
Mailing Address - Country:US
Mailing Address - Phone:415-455-9199
Mailing Address - Fax:415-455-9194
Practice Address - Street 1:1350 S ELISEO DR
Practice Address - Street 2:SUITE 120
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2011
Practice Address - Country:US
Practice Address - Phone:415-451-9476
Practice Address - Fax:415-451-4977
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65989208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics