Basic Information
| Provider Information | |||||||||
| NPI: | 1972732931 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PERUMAL | ||||||||
| FirstName: | DEEPA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4361 RAILROAD AVE | ||||||||
| Address2: | |||||||||
| City: | PLEASANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945666611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254621755 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 W LAUREL ST | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 673013211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203323280 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2009 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 7292 | KS | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0435477 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200968320A | 05 | KS | MEDICAID |