Healthcare Provider Details

I. General information

NPI: 1770838641
Provider Name (Legal Business Name): ALICIA E IDLER-PEREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 S 16TH ST
MILWAUKEE WI
53204-2711
US

IV. Provider business mailing address

8532 W CAPITOL DR
MILWAUKEE WI
53222-1848
US

V. Phone/Fax

Practice location:
  • Phone: 414-831-0100
  • Fax: 414-831-1584
Mailing address:
  • Phone: 414-463-2607
  • Fax: 414-463-6743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number57249-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: