Provider Demographics
NPI:1477587277
Name:PEREZ, TONY (DPM)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24937 WINTERBERRY LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5687
Mailing Address - Country:US
Mailing Address - Phone:312-842-2230
Mailing Address - Fax:312-842-9737
Practice Address - Street 1:436 W 31ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3136
Practice Address - Country:US
Practice Address - Phone:312-842-2230
Practice Address - Fax:312-842-9737
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003875213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL750160Medicare ID - Type Unspecified
ILT38506Medicare UPIN