Healthcare Provider Details

I. General information

NPI: 1659533701
Provider Name (Legal Business Name): MARISA PEREZ-REISLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SKOKIE BLVD STE 1A
NORTHBROOK IL
60062-2822
US

IV. Provider business mailing address

601 SKOKIE BLVD STE 1A
NORTHBROOK IL
60062-2822
US

V. Phone/Fax

Practice location:
  • Phone: 847-892-7300
  • Fax: 847-892-7301
Mailing address:
  • Phone: 847-892-7300
  • Fax: 847-892-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number16298
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number16298
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036.145235
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: