Provider Demographics
NPI:1053983833
Name:PEREZ PEREZ, NILDA DISARIS (MD)
Entity type:Individual
Prefix:
First Name:NILDA
Middle Name:DISARIS
Last Name:PEREZ PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MICHIGAN ST NE STE 3003
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2528
Mailing Address - Country:US
Mailing Address - Phone:616-267-2500
Mailing Address - Fax:616-267-2501
Practice Address - Street 1:35 MICHIGAN ST NE STE 3003
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2528
Practice Address - Country:US
Practice Address - Phone:616-267-2500
Practice Address - Fax:616-267-2501
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program