Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | D0068427 | MD |
Y | 207R00000X | Internist | D0068427 | MD |
Y | 111NI0900X | Internist | D0068427 | MD |
NPI | 1013042209 |
---|---|
Provider Name | Dr. Michael Edward Perraut |
First Address | Hollywood, MD 20636 |
Second Address | California, MD 20619-5009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 20/04/2018 |