Healthcare Provider Details

I. General information

NPI: 1982052411
Provider Name (Legal Business Name): CAROLINA MARIA PEREZ DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 GRANT LINE RD
NEW ALBANY IN
47150-2492
US

IV. Provider business mailing address

734 W MAIN ST STE 106
LOUISVILLE KY
40202-3622
US

V. Phone/Fax

Practice location:
  • Phone: 812-725-7542
  • Fax:
Mailing address:
  • Phone: 502-804-4811
  • Fax: 502-242-3311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number246267
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07001305A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: