Provider Demographics
NPI:1740316124
Name:PEERBHAI, MURTUZA A (DPM)
Entity type:Individual
Prefix:
First Name:MURTUZA
Middle Name:A
Last Name:PEERBHAI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W BROADWAY ST
Mailing Address - Street 2:APARTMENT 311
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-2110
Mailing Address - Country:US
Mailing Address - Phone:617-510-2656
Mailing Address - Fax:
Practice Address - Street 1:101 W BROADWAY ST
Practice Address - Street 2:APARTMENT 311
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-2110
Practice Address - Country:US
Practice Address - Phone:617-510-2656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001110A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery