Provider Demographics
NPI:1881655397
Name:PEREZ-TAMAYO, RUHERI A (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:RUHERI
Middle Name:A
Last Name:PEREZ-TAMAYO
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:ANTHONY
Other - Last Name:PEREZ-TAMAYO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:321 S ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6307
Mailing Address - Country:US
Mailing Address - Phone:708-822-3064
Mailing Address - Fax:866-288-5185
Practice Address - Street 1:4309 MEDICAL CENTER DRIVE
Practice Address - Street 2:STE. A200
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050
Practice Address - Country:US
Practice Address - Phone:815-759-4699
Practice Address - Fax:815-759-8938
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361000232086S0102X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
H43219Medicare UPIN