Healthcare Provider Details

I. General information

NPI: 1700881224
Provider Name (Legal Business Name): ROBERT S PERHALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date: 03/20/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

36855 AMERICAN WAY STE A
AVON OH
44011-4054
US

IV. Provider business mailing address

24701 EUCLID AVE THIRD FLOOR BILLING SERVICES
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 440-934-2200
  • Fax: 440-934-8684
Mailing address:
  • Phone: 440-934-2200
  • Fax: 440-934-8684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number35054958
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: