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General NPI Number Information
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NPI Number | 1356459549
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Entity Type | Individual
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Provider Name | THEISHA Y PERKINS MD
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Gender | Female
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 01/27/2016
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Provider Practice Location Address
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Address Line | 364 TORRENCE AVE
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City | CALUMET CITY
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State | IL
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Zip | 60409
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Country | US
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Telephone | 708-868-9457
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Fax | 708-868-6910
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Provider Business Mailing Address
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Address Line | 9119 S EXCHANGE AVE 9718 S. HALSTED
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City | CHICAGO
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State | IL
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Zip | 60617-4225
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Country | US
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Telephone | 773-768-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036106661
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License Number State | IL
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