Provider Demographics
NPI:1386659886
Name:PERROS, DIMITRI G (MD)
Entity Type:Individual
Prefix:DR
First Name:DIMITRI
Middle Name:G
Last Name:PERROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:800 AUSTIN ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3439
Mailing Address - Country:US
Mailing Address - Phone:847-864-7760
Mailing Address - Fax:847-864-0984
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:SUITE 507
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:847-864-7760
Practice Address - Fax:847-864-0984
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-048039207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036048039Medicaid
IL131051300OtherUS DEPT OF LABOR
IL4074893OtherAETNA
IL180009714OtherRAILROAD MEDICARE
ID21608516OtherBLUECROSS BLUE SHIELD
ILC42238Medicare UPIN
IL131051300OtherUS DEPT OF LABOR