MEDICARE: JACK B PERLMUTTER 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	207X00000X	Orthopaedic Surgery Physician	036070720	IL
2	174400000X	Specialist	036.070720	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

General Provider Information

NPI Number	:	1578559019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK B PERLMUTTER M.D.

Provider Business Mailing Address
First Line	:	22285 N PEPPER RD STE 105
Second Line	:
City	:	LAKE BARRINGTON
State	:	IL
Zip	:	60010-2539
Country	:	US
Telephone Number	:	847-277-9100
Fax Number	:	847-277-9110

Provider Business Practice Location Address
First Line	:	22285 N PEPPER RD STE 105
Second Line	:
City	:	LAKE BARRINGTON
State	:	IL
Zip	:	60010-2539
Country	:	US
Telephone Number	:	847-277-9100
Fax Number	:	847-277-9110

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	08/30/2021

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