Healthcare Provider Details

I. General information

NPI: 1437368479
Provider Name (Legal Business Name): PRAVEEN C PERNI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12174 N MERIDIAN ST STE 100
CARMEL IN
46032-4578
US

IV. Provider business mailing address

12174 N MERIDIAN ST STE 100
CARMEL IN
46032-4578
US

V. Phone/Fax

Practice location:
  • Phone: 317-208-3866
  • Fax: 317-208-3867
Mailing address:
  • Phone: 317-208-3866
  • Fax: 317-208-3867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number01067826A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: