Provider Demographics
NPI:1477533669
Name:PERLMAN, JAY I (MD PHD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:I
Last Name:PERLMAN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 S 5TH AVE
Mailing Address - Street 2:SURGERY SERVICE
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141-3030
Mailing Address - Country:US
Mailing Address - Phone:708-202-5134
Mailing Address - Fax:708-202-2493
Practice Address - Street 1:5000 S 5TH AVE
Practice Address - Street 2:SURGERY SERVICE
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-3030
Practice Address - Country:US
Practice Address - Phone:708-202-5134
Practice Address - Fax:708-202-2493
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082464207W00000X
IL36082464207ZN0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36082464Medicaid
IL36082464Medicaid
F85854Medicare UPIN