Provider Demographics
NPI:1659382620
Name:MANUEL PEREZ, M.D.,S.C.
Entity Type:Organization
Organization Name:MANUEL PEREZ, M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-755-3255
Mailing Address - Street 1:1575 BARRINGTON RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60194-1057
Mailing Address - Country:US
Mailing Address - Phone:847-755-3255
Mailing Address - Fax:
Practice Address - Street 1:1575 BARRINGTON RD
Practice Address - Street 2:SUITE 209
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60194-1057
Practice Address - Country:US
Practice Address - Phone:847-755-3255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1627135OtherBLUE CROSS BLUE SHIELD
IL036082167Medicaid
ILE34408Medicare UPIN
IL626530Medicare ID - Type Unspecified