Healthcare Provider Details

I. General information

NPI: 1437458072
Provider Name (Legal Business Name): TINA MICHELLE PERRON DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13295 ILLINOIS ST STE 104
CARMEL IN
46032-3025
US

IV. Provider business mailing address

13295 ILLINOIS ST SUITE 104
CARMEL INDIANA
46032
UM

V. Phone/Fax

Practice location:
  • Phone: 317-218-4095
  • Fax: 317-733-3041
Mailing address:
  • Phone: 317-218-4095
  • Fax: 317-733-3041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07001173A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: