MEDICARE: DR. JENNIFER M. PERUSEK DVM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174M00000X	Veterinarian	24006379A	IN

General Provider Information

NPI Number	:	1730207622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER M. PERUSEK DVM

Provider Business Mailing Address
First Line	:	12268 WESLEY PL
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-3047
Country	:	US
Telephone Number	:	574-850-7963
Fax Number	:

Provider Business Practice Location Address
First Line	:	83 SKYVIEW DR
Second Line	:
City	:	CHESTERFIELD
State	:	IN
Zip	:	46017-1056
Country	:	US
Telephone Number	:	765-378-3694
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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