Healthcare Provider Details

I. General information

NPI: 1346551082
Provider Name (Legal Business Name): DAVID PEREZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 CHARLES ST
BANGOR MI
49013-1317
US

IV. Provider business mailing address

308 CHARLES ST
BANGOR MI
49013-1317
US

V. Phone/Fax

Practice location:
  • Phone: 269-427-7967
  • Fax: 269-427-7574
Mailing address:
  • Phone: 269-427-7967
  • Fax: 269-427-7574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11015729A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101018510
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: