MEDICARE: MS. MARIA T PEREZ M.D.

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	207Q00000X	Family Medicine Physician	036-098979	IL

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
2	01616720	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1285811166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA T PEREZ M.D.

Provider Business Mailing Address
First Line	:	2003 W FULTON ST
Second Line	:	STE 303
City	:	CHICAGO
State	:	IL
Zip	:	60612-2345
Country	:	US
Telephone Number	:	618-662-2191
Fax Number	:	618-662-2191

Provider Business Practice Location Address
First Line	:	2003 W FULTON ST STE 303
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-2345
Country	:	US
Telephone Number	:	312-243-2223
Fax Number	:

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

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	01/24/2019

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