Healthcare Provider Details

I. General information

NPI: 1821678731
Provider Name (Legal Business Name): ALAN JEROME PEREZ-RATHKE MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 10/08/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 24TH AVE S
NASHVILLE TN
37212-2637
US

IV. Provider business mailing address

6135 N WOLCOTT AVE UNIT 2
CHICAGO IL
60660-2323
US

V. Phone/Fax

Practice location:
  • Phone: 615-225-3700
  • Fax: 615-873-8121
Mailing address:
  • Phone: 312-519-7470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: