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NPI Code Detail

MEDICARE: DR. ISAIAH J PERRY M.D.

MEDICARE: DR. ISAIAH J PERRY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician036059418IL

General Provider Information

NPI Number : 1316960875
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ISAIAH J PERRY M.D.
Provider Business Mailing Address
First Line : 7615 ROOSEVELT RD
Second Line : APT.1
City : FOREST PARK
State : IL
Zip : 60130-3002
Country : US
Telephone Number : 708-488-1915
Fax Number :
Provider Business Practice Location Address
First Line : 5470 W MADISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60644-4031
Country : US
Telephone Number : 773-287-7900
Fax Number : 773-287-5923
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 04/17/2013

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