Provider Demographics
NPI:1134115231
Name:PEREZ-TAMAYO, ALEJANDRA (MD)
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:PEREZ-TAMAYO
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 1:840 S WOOD ST # MC958
Mailing Address - Street 2:SUITE 618
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-355-0104
Mailing Address - Fax:312-355-3764
Practice Address - Street 1:1801 W TAYLOR ST
Practice Address - Street 2:3F-OCC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4795
Practice Address - Country:US
Practice Address - Phone:312-996-6883
Practice Address - Fax:312-413-1206
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065562208600000X, 2086S0122X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036065562Medicaid
ILP00129722OtherRAILROAD MEDICARE
IL21622027OtherBCBS PROVIDER ID
IL020052881OtherRAILROAD MEDICARE
IL202351OtherBCBS PROVIDER ID
ILL66295Medicare PIN
IL020052881Medicare PIN
IL036065562Medicaid
ILD89935Medicare UPIN
ILL92670Medicare PIN