Provider Demographics
NPI:1003812876
Name:PEERA, AURELIA Z (MD)
Entity Type:Individual
Prefix:
First Name:AURELIA
Middle Name:Z
Last Name:PEERA
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 1:4801 W PETERSON AVE
Mailing Address - Street 2:STE 506
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5795
Mailing Address - Country:US
Mailing Address - Phone:773-777-5437
Mailing Address - Fax:773-777-7567
Practice Address - Street 1:4801 W PETERSON AVE
Practice Address - Street 2:STE 506
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5795
Practice Address - Country:US
Practice Address - Phone:773-777-5437
Practice Address - Fax:773-777-7567
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01615555OtherBLUE SHIELD PROVIDER #