Provider Demographics
NPI:1700881224
Name:PERHALA, ROBERT S (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:PERHALA
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 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-934-2200
Mailing Address - Fax:440-934-8684
Practice Address - Street 1:36855 AMERICAN WAY
Practice Address - Street 2:STE A
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-4054
Practice Address - Country:US
Practice Address - Phone:440-934-2200
Practice Address - Fax:440-934-8684
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2021-05-26
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
OH35054958207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0738063Medicaid
OH0738063Medicaid
OH4154811Medicare PIN
OH00204114Medicare PIN