Healthcare Provider Details

I. General information

NPI: 1730207622
Provider Name (Legal Business Name): JENNIFER M. PERUSEK DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 SKYVIEW DR
CHESTERFIELD IN
46017-1056
US

IV. Provider business mailing address

12268 WESLEY PL
FISHERS IN
46038-3047
US

V. Phone/Fax

Practice location:
  • Phone: 765-378-3694
  • Fax:
Mailing address:
  • Phone: 574-850-7963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number24006379A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: