MEDICARE: MR. JUAN PERRY C. VERON PA-C, ATC

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	2255A2300X	Athletic Trainer	096002321	IL
2	363A00000X	Physician Assistant	085003757	IL

General Provider Information

NPI Number	:	1245388545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUAN PERRY C. VERON PA-C, ATC

Provider Business Mailing Address
First Line	:	4842 W HUTCHINSON ST
Second Line	:	#207
City	:	CHICAGO
State	:	IL
Zip	:	60641-1621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4842 W HUTCHINSON ST
Second Line	:	#207
City	:	CHICAGO
State	:	IL
Zip	:	60641-1621
Country	:	US
Telephone Number	:	773-283-7712
Fax Number	:

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	02/13/2016

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