Provider Demographics
NPI:1841287463
Name:PEREZ CRUET, MIGUELANGELO (MD)
Entity type:Individual
Prefix:
First Name:MIGUELANGELO
Middle Name:
Last Name:PEREZ CRUET
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 1:29275 NORTHWESTERN HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1044
Mailing Address - Country:US
Mailing Address - Phone:877-784-3667
Mailing Address - Fax:248-784-3743
Practice Address - Street 1:3577 WEST THIRTEEN MILE RD
Practice Address - Street 2:STE. 206
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0460
Practice Address - Country:US
Practice Address - Phone:877-784-3667
Practice Address - Fax:248-551-0461
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301082604174400000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH34383Medicare UPIN
MI0Q26462Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER