Healthcare Provider Details

I. General information

NPI: 1568104529
Provider Name (Legal Business Name): ERIN NICOLE PEREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 CHESTER BLVD
RICHMOND IN
47374-1919
US

IV. Provider business mailing address

1100 REID PKWY PAYOR ENROLLMENT
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-966-5527
  • Fax: 765-966-5528
Mailing address:
  • Phone: 765-983-3392
  • Fax: 765-935-8592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01096853A
License Number StateIN
# 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: