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NPI Code Detail

MEDICARE: DR. KENNETH E PERES MD

MEDICARE: DR. KENNETH E PERES MD
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
12084P0800XPsychiatry Physician17518MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801967674
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH E PERES MD
Provider Business Mailing Address
First Line : 2311 HIGHWAY 15 S
Second Line :
City : LOUISVILLE
State : MS
Zip : 39339-7071
Country : US
Telephone Number : 662-779-0119
Fax Number :
Provider Business Practice Location Address
First Line : 2311 HIGHWAY 15 S
Second Line :
City : LOUISVILLE
State : MS
Zip : 39339-7071
Country : US
Telephone Number : 662-779-0119
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2006
Last Update Date : 07/08/2007

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Directions to “ DR. KENNETH E PERES MD” Practice Location

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