Provider Demographics
NPI:1730272915
Name:PERNA, IGNAZIO DOMINIC (DPM)
Entity type:Individual
Prefix:
First Name:IGNAZIO
Middle Name:DOMINIC
Last Name:PERNA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5889 WHITMORE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1998
Mailing Address - Country:US
Mailing Address - Phone:810-227-4155
Mailing Address - Fax:810-227-0845
Practice Address - Street 1:5889 WHITMORE LAKE RD STE A
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1998
Practice Address - Country:US
Practice Address - Phone:810-227-4155
Practice Address - Fax:810-227-0845
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001888213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3113590Medicaid
MIU83163Medicare UPIN
MI9475002Medicare ID - Type Unspecified