Provider Demographics
NPI:1730207622
Name:PERUSEK, JENNIFER M (DVM)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:PERUSEK
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12268 WESLEY PL
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3047
Mailing Address - Country:US
Mailing Address - Phone:574-850-7963
Mailing Address - Fax:
Practice Address - Street 1:83 SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:IN
Practice Address - Zip Code:46017-1056
Practice Address - Country:US
Practice Address - Phone:765-378-3694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24006379A174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian