Healthcare Provider Details

I. General information

NPI: 1457568016
Provider Name (Legal Business Name): CLAUDIA BETH PEREZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

2160 S 1ST AVE
MAYWOOD IL
60153-3328
US

V. Phone/Fax

Practice location:
  • Phone: 708-216-9000
  • Fax: 708-216-8546
Mailing address:
  • Phone: 708-216-9000
  • Fax: 708-216-8546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number036122888
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: