1710987847 NPI number — RATNAVALI BUTCHI PERLA MD

Table of content: RATNAVALI BUTCHI PERLA MD (NPI 1710987847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710987847 NPI number — RATNAVALI BUTCHI PERLA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERLA
Provider First Name:
RATNAVALI
Provider Middle Name:
BUTCHI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1710987847
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26850 PROVIDENCE PKWY
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
NOVI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48374-1213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-662-4091
Provider Business Mailing Address Fax Number:
248-662-0365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26850 PROVIDENCE PKWY
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48374-1213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-662-4091
Provider Business Practice Location Address Fax Number:
248-662-0365
Provider Enumeration Date:
07/29/2005

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: 2080N0001X , with the licence number:  4301043368 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1770115-10 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 453429210 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 177011510 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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