Provider Demographics
NPI:1467558510
Name:PERILMAN, STEVEN KYLE (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:KYLE
Last Name:PERILMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STEVEN
Other - Middle Name:KYLE
Other - Last Name:PERILMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:6621 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2358
Practice Address - Country:US
Practice Address - Phone:832-824-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4430207P00000X, 207PP0204X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134992008Medicaid
TX121320100OtherFIRSTCARE PIN
TX137283103Medicaid
TX5040636OtherAETNA PIN
TX137345805Medicaid
TX4731603OtherCIGNA PIN
TX10022295OtherAMERIGROUP PIN
TX00L42VOtherBCBSTX GRP PIN
TX108867OtherSUPERIOR PIN
1669442042OtherGRP NPI NUMBER
TX1854186OtherFIRSTHEALTH PIN
TX88629XOtherBCBSTX IND PIN
TX134992007Medicaid
TX1415257OtherUHC PIN
G15191Medicare UPIN
TX137345805Medicaid
TX00L42VMedicare PIN