Healthcare Provider Details

I. General information

NPI: 1730272915
Provider Name (Legal Business Name): IGNAZIO DOMINIC PERNA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5889 WHITMORE LAKE RD STE A
BRIGHTON MI
48116-1998
US

IV. Provider business mailing address

5889 WHITMORE LAKE RD
BRIGHTON MI
48116-1998
US

V. Phone/Fax

Practice location:
  • Phone: 810-227-4155
  • Fax: 810-227-0845
Mailing address:
  • Phone: 810-227-4155
  • Fax: 810-227-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901001888
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: