Provider Demographics
NPI:1205880317
Name:PEREZ-SANZ, JOSE R (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:PEREZ-SANZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 W 95TH ST
Mailing Address - Street 2:SUITE 6581
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2105
Mailing Address - Country:US
Mailing Address - Phone:708-599-5000
Mailing Address - Fax:708-599-5000
Practice Address - Street 1:6701 W 95TH ST
Practice Address - Street 2:SUITE 6581
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2105
Practice Address - Country:US
Practice Address - Phone:708-599-5000
Practice Address - Fax:708-599-5000
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-067558207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036067558OtherSTATE LICENSE
IL200021469OtherRAILROAD MEDICARE PROVIDER NUMBER
IL036067558OtherBLUE CROSS BLUE SHIELD PROVIDER NUMBER
IL036067558OtherBLUE CROSS BLUE SHIELD PROVIDER NUMBER
IL200021469OtherRAILROAD MEDICARE PROVIDER NUMBER