Individual
MARCELLA DENISE PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5109 NEW CUT RD, LOUISVILLE, KY 40214-2745
(502) 361-1197
(502) 361-0090
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
46859
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000885932
ANTHEM-NCMA
KY
01
—
165148
SIHO
KY
01
—
50075460
PASSPORT - NCMA OKOLONA
KY
01
—
50083958
PASSPORT - NCMA IROQUOIS
KY
05
—
7100318020
—
KY
Enumeration date
03/22/2011
Last updated
09/12/2016
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