MEDICARE: DR. MIEKE J PEREZ 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
1	207R00000X	Internal Medicine Physician	23381	SC

Other Identifiers

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

General Provider Information

NPI Number	:	1881670305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIEKE J PEREZ MD

Provider Business Mailing Address
First Line	:	PO BOX 743904
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-3904
Country	:	US
Telephone Number	:	803-296-7320
Fax Number	:	803-296-7330

Provider Business Practice Location Address
First Line	:	14 RICHLAND MEDICAL PARK DR STE 320
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6896
Country	:	US
Telephone Number	:	803-434-6771
Fax Number	:	803-434-3955

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	03/17/2018

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