Provider Demographics
NPI:1043328255
Name:PERRY, LAMORRIS L (MD)
Entity Type:Individual
Prefix:MR
First Name:LAMORRIS
Middle Name:L
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LAMORRIS
Other - Middle Name:L
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1818 HEATHER HILL
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422
Mailing Address - Country:US
Mailing Address - Phone:773-233-4100
Mailing Address - Fax:773-233-8542
Practice Address - Street 1:2045 W. WASHINGTON BLVD M/C 698
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-2428
Practice Address - Country:US
Practice Address - Phone:312-996-2000
Practice Address - Fax:312-413-7812
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069919208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069919Medicaid
ILK12069Medicare ID - Type Unspecified
IL036069919Medicaid