MEDICARE: FELIPE PEREN ENRIQUEZ 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	207RP1001X	Pulmonary Disease Physician	17408	NV
2	2278P1004X	Pulmonary Diagnostics Certified Respiratory Therapist	036056321	IL
3	207RP1001X	Pulmonary Disease Physician	036056321	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01070821	OTHER	IL	RR 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
2	0810037063	OTHER		BCBS IL

General Provider Information

NPI Number	:	1457305468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELIPE PEREN ENRIQUEZ MD

Provider Business Mailing Address
First Line	:	2570 24TH ST
Second Line	:	SUITE 124
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-5394
Country	:	US
Telephone Number	:	309-779-3670
Fax Number	:	309-779-3675

Provider Business Practice Location Address
First Line	:	2570 24TH ST
Second Line	:	SUITE 124
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-5394
Country	:	US
Telephone Number	:	309-779-3670
Fax Number	:	309-779-3675

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	08/08/2019

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Directions to “ FELIPE PEREN ENRIQUEZ MD” Practice Location

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