Individual
MR. MICHAEL J PERILLO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
21 STONEBRIAR RD, COLUMBIA, SC 29212-8531
(803) 407-5266
(803) 407-1455
Mailing address
PO BOX 1637, IRMO, SC 29063-1637
(803) 407-5266
(803) 407-1455
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
882
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN0953
—
SC
Enumeration date
05/08/2006
Last updated
10/15/2008
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