Provider Demographics
NPI:1366527137
Name:PEREA, MANUEL M (MD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:M
Last Name:PEREA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 DAVENPORT AVE
Mailing Address - Street 2:P O BOX 3272
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3652
Mailing Address - Country:US
Mailing Address - Phone:989-793-9830
Mailing Address - Fax:989-797-4077
Practice Address - Street 1:700 COOPER AVE
Practice Address - Street 2:900 BLDG
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5383
Practice Address - Country:US
Practice Address - Phone:989-583-4401
Practice Address - Fax:989-583-4409
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI02685272OtherHP
MI104634636Medicaid
MIP00265524OtherRAILROAD MR #
MI0207310972OtherBLUE CROSS BLUE SHIELD #
MIP00265524OtherRAILROAD MR #
MI02685272OtherHP