Provider Demographics
NPI:1245931211
Name:PEROSSA PSYCHIATRIC PRACTICE PLLC
Entity type:Organization
Organization Name:PEROSSA PSYCHIATRIC PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUNO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEROSSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-737-6772
Mailing Address - Street 1:400 S 4TH ST STE 410 #305330
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415
Mailing Address - Country:US
Mailing Address - Phone:865-737-6772
Mailing Address - Fax:
Practice Address - Street 1:5601 SMETANA DR
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-5000
Practice Address - Country:US
Practice Address - Phone:865-737-6772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty