Basic Information
| Provider Information | |||||||||
| NPI: | 1043448095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | KENNEDY | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 915 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182495555 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5450 FORT ST | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481834601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346713800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2009 | ||||||||
| LastUpdateDate: | 03/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 5101018312 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 20801 | MT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 63822 | MN | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.