Healthcare Provider Details

I. General information

NPI: 1679893341
Provider Name (Legal Business Name): MICHAEL PEREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 S DOBSON RD STE 512
MESA AZ
85202-4778
US

IV. Provider business mailing address

1432 S DOBSON RD STE 512
MESA AZ
85202-4778
US

V. Phone/Fax

Practice location:
  • Phone: 480-412-6336
  • Fax: 480-412-8013
Mailing address:
  • Phone: 480-412-6336
  • Fax: 480-412-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number036139941
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number58694
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: