Provider Demographics
NPI:1043213713
Name:PERNS, VINCENT ANTHONY (DPM)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:ANTHONY
Last Name:PERNS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 N HARLEM AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4684
Mailing Address - Country:US
Mailing Address - Phone:773-836-9900
Mailing Address - Fax:773-836-9935
Practice Address - Street 1:3115 N HARLEM AVE
Practice Address - Street 2:STE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4684
Practice Address - Country:US
Practice Address - Phone:773-836-9900
Practice Address - Fax:773-836-9935
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016002468213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016002468Medicaid
IL016002468Medicaid
IL518930Medicare ID - Type Unspecified