Provider Demographics
NPI:1750319034
Name:PEREZ, MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:PEREZ
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 1:1575 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:847-252-7939
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:847-252-7939
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082167Medicaid
IL01627135OtherBLUE CROSS BLUE SHIELD
ILE34408Medicare UPIN
ILK53353Medicare PIN