Individual
DR. MICHAEL PEREGRIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 UNIVERSITY BLVD, UH 1501, INDIANAPOLIS, IN 46202-5149
(317) 948-1310
(317) 948-0503
Mailing address
250 N SHADELAND AVE, STE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01072736A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201167720
—
IN
Enumeration date
04/08/2010
Last updated
02/04/2021
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