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General NPI Number Information
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NPI Number | 1467414052
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Entity Type | Individual
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Provider Name | RICHARD T PERRY MD
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Gender | Male
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 23829 LITTLE MACK AVE SUITE 100
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1186
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Country | US
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Telephone | 586-773-1300
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Fax | 586-773-1600
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Provider Business Mailing Address
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Address Line | 23829 LITTLE MACK AVE SUITE 100
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1186
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Country | US
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Telephone | 586-773-1300
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Fax | 586-773-1600
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | RP066358
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License Number State | MI
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