Provider Demographics
NPI:1790880177
Name:PERNI, SRIRAM (MD)
Entity type:Individual
Prefix:
First Name:SRIRAM
Middle Name:
Last Name:PERNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11371 CORTEZ BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5408
Mailing Address - Country:US
Mailing Address - Phone:352-663-9510
Mailing Address - Fax:352-251-0226
Practice Address - Street 1:11371 CORTEZ BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5408
Practice Address - Country:US
Practice Address - Phone:352-663-9510
Practice Address - Fax:352-251-0226
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35086214207VM0101X
FLME168708207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2592716Medicaid
FL122937400Medicaid
I46370Medicare UPIN