Provider Demographics
NPI:1578559019
Name:PERLMUTTER, JACK B (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:B
Last Name:PERLMUTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22285 N PEPPER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2539
Mailing Address - Country:US
Mailing Address - Phone:847-277-9100
Mailing Address - Fax:847-277-9110
Practice Address - Street 1:22285 N PEPPER RD STE 105
Practice Address - Street 2:
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2539
Practice Address - Country:US
Practice Address - Phone:847-277-9100
Practice Address - Fax:847-277-9110
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070720207X00000X
IL036.070720174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036070720Medicaid
ILL58226Medicare ID - Type Unspecified