Provider Demographics
NPI:1568456374
Name:PEREZ- ESPINDOLA, GERARDO (DPM)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:
Last Name:PEREZ- ESPINDOLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:GERARDO
Other - Middle Name:
Other - Last Name:PEREZ ESPINDOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:159 N GREENLEAF ST STE 1
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3341
Mailing Address - Country:US
Mailing Address - Phone:847-249-3888
Mailing Address - Fax:847-574-7477
Practice Address - Street 1:159 N GREENLEAF ST STE 1
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3341
Practice Address - Country:US
Practice Address - Phone:262-886-0000
Practice Address - Fax:847-574-7477
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005265213ES0103X
WI911-025213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIWI1874OtherMEDICARE PTAN
WI1568456374Medicaid
WI43241500Medicaid
IL016-005265Medicaid
ILIL4062OtherMEDICARE PTAN
WI1932454279OtherMEDICARE GROUP NPI
ILBP8685034OtherDEA
WI1568456374Medicaid
WI1932454279OtherMEDICARE GROUP NPI
ILBP8685034OtherDEA#