Provider Demographics
NPI:1811933302
Name:PERIJOC, MIHAELA (MD)
Entity type:Individual
Prefix:
First Name:MIHAELA
Middle Name:
Last Name:PERIJOC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 SNIDER PLZ
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-5648
Mailing Address - Country:US
Mailing Address - Phone:972-381-6690
Mailing Address - Fax:214-361-2552
Practice Address - Street 1:6901 SNIDER PLZ
Practice Address - Street 2:SUITE 130
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-5648
Practice Address - Country:US
Practice Address - Phone:972-381-6690
Practice Address - Fax:214-361-2552
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037727703Medicaid
TX8H9435OtherBC/BS
TX110247512Medicare PIN
TXTXB112611Medicare PIN
TXTXB117070Medicare PIN
TX037727703Medicaid
TX8A3754Medicare PIN