=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568104529
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN NICOLE PEREZ MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2022
-----------------------------------------------------
Last Update Date | 12/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1485 CHESTER BLVD
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47374-1919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-966-5527
-----------------------------------------------------
Fax | 765-966-5528
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1100 REID PKWY PAYOR ENROLLMENT
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47374-1157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-983-3392
-----------------------------------------------------
Fax | 765-935-8592
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 01096853A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------