Provider Demographics
NPI:1285747105
Name:PERRI, MICHAEL G (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:PERRI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:GERARD
Other - Last Name:PERRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100166
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0166
Mailing Address - Country:US
Mailing Address - Phone:352-273-6150
Mailing Address - Fax:352-273-6199
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-6150
Practice Address - Fax:352-273-6199
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4419103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL211997800Medicaid
FL74479XMedicare PIN
FL74479YMedicare PIN
FL211997800Medicaid