Provider Demographics
NPI:1255528535
Name:PERES EDELSON, DANA P (MD, MS)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:P
Last Name:PERES EDELSON
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:P
Other - Last Name:EDELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MS
Mailing Address - Street 1:180 HARVESTER DR
Mailing Address - Street 2:SUITE 110, MC 1099
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7594
Mailing Address - Country:US
Mailing Address - Phone:773-834-4740
Mailing Address - Fax:773-834-0946
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MC 5000, W312
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-834-2191
Practice Address - Fax:773-834-2238
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111499Medicaid
IL036111499Medicaid
ILK19094Medicare PIN