MEDICARE: DR. TINA MICHELLE PERRON DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	213E00000X	Podiatrist	07001173A	IN

General Provider Information

NPI Number	:	1437458072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TINA MICHELLE PERRON DPM

Provider Business Mailing Address
First Line	:	13295 ILLINOIS ST SUITE 104
Second Line	:
City	:	CARMEL
State	:	INDIANA
Zip	:	46032
Country	:	UM
Telephone Number	:	317-218-4095
Fax Number	:	317-733-3041

Provider Business Practice Location Address
First Line	:	13295 ILLINOIS ST STE 104
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-3025
Country	:	US
Telephone Number	:	317-218-4095
Fax Number	:	317-733-3041

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2011
Last Update Date	:	09/10/2014

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