1366527137 NPI number — MANUEL M PEREA M.D.

Table of content: MANUEL M PEREA M.D. (NPI 1366527137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366527137 NPI number — MANUEL M PEREA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREA
Provider First Name:
MANUEL
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366527137
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3023 DAVENPORT AVE
Provider Second Line Business Mailing Address:
P O BOX 3272
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48602-3652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-793-9830
Provider Business Mailing Address Fax Number:
989-797-4077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 COOPER AVE
Provider Second Line Business Practice Location Address:
900 BLDG
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48602-5383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-583-4401
Provider Business Practice Location Address Fax Number:
989-583-4409
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02685272 . This is a "HP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104634636 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00265524 . This is a "RAILROAD MR #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0207310972 . This is a "BLUE CROSS BLUE SHIELD #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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