Provider Demographics
NPI:1104230374
Name:AMITAI, ARI DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:ARI
Middle Name:DAVID
Last Name:AMITAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ARI
Other - Middle Name:DAVID
Other - Last Name:PERLSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4140 CENTENNIAL HILLS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3265
Mailing Address - Country:US
Mailing Address - Phone:307-265-7205
Mailing Address - Fax:307-235-6262
Practice Address - Street 1:4140 CENTENNIAL HILLS BLVD STE A
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-3265
Practice Address - Country:US
Practice Address - Phone:307-265-7205
Practice Address - Fax:307-235-6262
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORFE167365207X00000X, 207XP3100X
WAMD61448004207X00000X
UT10391490-1205207X00000X
WY12630A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORFE167365OtherLICENSE