Healthcare Provider Details

I. General information

NPI: 1114283082
Provider Name (Legal Business Name): ROBERT PERELMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 NW POINT BLVD
ELK GROVE VILLAGE IL
60007-1019
US

IV. Provider business mailing address

141 NORTHWEST POINT BLVD
ELK GROVE VILLAGE IL
60007-1098
US

V. Phone/Fax

Practice location:
  • Phone: 847-434-7898
  • Fax:
Mailing address:
  • Phone: 847-434-7898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20881-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: