Provider Demographics
NPI:1285626101
Name:PERLIS, CHERYL L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:L
Last Name:PERLIS
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 1:1780 GREEN BAY RD STE 204
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3276
Mailing Address - Country:US
Mailing Address - Phone:847-295-5997
Mailing Address - Fax:
Practice Address - Street 1:1780 GREEN BAY RD STE 204
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3276
Practice Address - Country:US
Practice Address - Phone:847-295-5997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
IL036.0780302083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK01237Medicaid
ILK01237Medicare ID - Type Unspecified
ILK01237Medicaid