Healthcare Provider Details

I. General information

NPI: 1770789992
Provider Name (Legal Business Name): CESAR ELIUD ESCARENO PEREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRIGHAM AND WOMEN'S HOSPITAL SURGERY 75 FRANCIS STREET
BOSTON MA
02115
US

IV. Provider business mailing address

240 EAST HURON ST STE 1-200
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-6861
  • Fax:
Mailing address:
  • Phone: 312-503-7975
  • Fax: 312-503-5230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number231848
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036136270
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: