Healthcare Provider Details

I. General information

NPI: 1114140167
Provider Name (Legal Business Name): RALPH D PEARLMAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22250 PROVIDENCE DR STE 702
SOUTHFIELD MI
48075-6215
US

IV. Provider business mailing address

22250 PROVIDENCE DR STE 702
SOUTHFIELD MI
48075-6215
US

V. Phone/Fax

Practice location:
  • Phone: 248-557-9650
  • Fax: 248-557-5033
Mailing address:
  • Phone: 248-557-9650
  • Fax: 248-557-5033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberRP045454
License Number StateMI

VIII. Authorized Official

Name: RALPH PEARLMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 248-557-9650