Healthcare Provider Details

I. General information

NPI: 1164618302
Provider Name (Legal Business Name): BROOKE MICHELLE PERLIK PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34600 CHARDON RD UNIT 7
WILLOUGHBY HILLS OH
44094-8481
US

IV. Provider business mailing address

34600 CHARDON RD UNIT 7
WILLOUGHBY HILLS OH
44094-8481
US

V. Phone/Fax

Practice location:
  • Phone: 440-602-6737
  • Fax: 440-942-0316
Mailing address:
  • Phone: 440-602-6737
  • Fax: 440-942-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number50.002657RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.002657
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: