Provider Demographics
NPI:1689830077
Name:PEREZ, JENNIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 S PULASKI RD
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4417
Mailing Address - Country:US
Mailing Address - Phone:773-284-9270
Mailing Address - Fax:773-284-6290
Practice Address - Street 1:5525 S PULASKI RD
Practice Address - Street 2:SUITE 24OO
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4417
Practice Address - Country:US
Practice Address - Phone:773-284-6270
Practice Address - Fax:773-284-6290
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL366084052208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics