Provider Demographics
NPI:1821678731
Name:PEREZ-RATHKE, ALAN JEROME (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:JEROME
Last Name:PEREZ-RATHKE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6135 N WOLCOTT AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-2323
Mailing Address - Country:US
Mailing Address - Phone:312-519-7470
Mailing Address - Fax:
Practice Address - Street 1:1310 24TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2637
Practice Address - Country:US
Practice Address - Phone:615-225-3700
Practice Address - Fax:615-873-8121
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program