Provider Demographics
NPI:1811243397
Name:PERSE, JEREMY (DPM)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:PERSE
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:PO BOX 932127
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0008
Mailing Address - Country:US
Mailing Address - Phone:216-363-2730
Mailing Address - Fax:
Practice Address - Street 1:10553 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-1973
Practice Address - Country:US
Practice Address - Phone:216-682-7702
Practice Address - Fax:216-920-6273
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-003674213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0085043Medicaid
OHH199490Medicare PIN