Provider Demographics
NPI:1477587277
Name:PEREZ, TONY (DPM)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:R
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:24937 WINTERBERRY LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5687
Mailing Address - Country:US
Mailing Address - Phone:312-842-2230
Mailing Address - Fax:312-842-9737
Practice Address - Street 1:537 W 31ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3294
Practice Address - Country:US
Practice Address - Phone:312-842-2230
Practice Address - Fax:312-842-9737
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003875213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL750160Medicare ID - Type Unspecified
ILT38506Medicare UPIN