Provider Demographics
NPI:1457305468
Name:ENRIQUEZ, FELIPE PEREN (MD)
Entity Type:Individual
Prefix:
First Name:FELIPE
Middle Name:PEREN
Last Name:ENRIQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2570 24TH ST
Mailing Address - Street 2:SUITE 124
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5394
Mailing Address - Country:US
Mailing Address - Phone:309-779-3670
Mailing Address - Fax:309-779-3675
Practice Address - Street 1:2570 24TH ST
Practice Address - Street 2:SUITE 124
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5394
Practice Address - Country:US
Practice Address - Phone:309-779-3670
Practice Address - Fax:309-779-3675
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2019-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV17408207RP1001X
IL0360563212278P1004X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No2278P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Diagnostics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1457305468Medicaid
0810037063OtherBCBS IL
ILP01070821OtherRR MEDICARE
IA719260681Medicare PIN
0810037063OtherBCBS IL
C44930Medicare UPIN