Healthcare Provider Details

I. General information

NPI: 1134360167
Provider Name (Legal Business Name): PEDRO ANTONIO PEREZ CARTAGENA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2009
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30S CAYUGA RD
WILLIAMSVILLE NY
14221-5443
US

IV. Provider business mailing address

1201 MICHIGAN AVE SUITE 70
LOGANSPORT IN
46947-1580
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-1088
  • Fax:
Mailing address:
  • Phone: 574-753-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01064949A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number13604
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number01064949A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number252166
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: