MEDICARE: ALEJANDRA PEREZ-TAMAYO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	036065562	IL
2	2086S0122X	Plastic and Reconstructive Surgery Physician	036065562	IL
3	2086X0206X	Surgical Oncology Physician	036065562	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00129722	OTHER	IL	RAILROAD MEDICARE
4	020052881	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	21622027	OTHER	IL	BCBS PROVIDER ID
5	202351	OTHER	IL	BCBS PROVIDER ID

General Provider Information

NPI Number	:	1134115231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEJANDRA PEREZ-TAMAYO MD

Provider Business Mailing Address
First Line	:	840 S WOOD ST # MC958
Second Line	:	SUITE 618
City	:	CHICAGO
State	:	IL
Zip	:	60612-4325
Country	:	US
Telephone Number	:	312-355-0104
Fax Number	:	312-355-3764

Provider Business Practice Location Address
First Line	:	1801 W TAYLOR ST
Second Line	:	3F-OCC
City	:	CHICAGO
State	:	IL
Zip	:	60612-4795
Country	:	US
Telephone Number	:	312-996-6883
Fax Number	:	312-413-1206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	03/13/2021

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Directions to “ ALEJANDRA PEREZ-TAMAYO MD” Practice Location

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