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General NPI Number Information
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NPI Number | 1053716795
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Entity Type | Organization
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Legal Business Name | MANUEL PEREZ, M.D.,S.C.
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 12/20/2021
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Provider Practice Location Address
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Address Line | 19621 LA GRANGE RD
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City | MOKENA
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State | IL
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Zip | 60448-9360
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Country | US
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Telephone | 708-465-4559
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Fax |
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Provider Business Mailing Address
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Address Line | 19934 WOLF RD #558
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City | MOKENA
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State | IL
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Zip | 60448-2101
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Country | US
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Telephone | 708-465-4559
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MANUEL PEREZ
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Credential | M.D.
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Telephone | 708-465-4559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 036084064
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License Number State | IL
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