Healthcare Provider Details

I. General information

NPI: 1649533688
Provider Name (Legal Business Name): MICHELLE ILLYSA PEARLMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136
US

IV. Provider business mailing address

1120 NW 14TH ST STE 1112D-49
MIAMI FL
33136-2107
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-8644
  • Fax: 305-689-1820
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME135328
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: