MEDICARE: MANUEL 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	207R00000X	Internal Medicine Physician	036082167	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	01627135	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1750319034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANUEL PEREZ M.D.

Provider Business Mailing Address
First Line	:	1575 BARRINGTON RD
Second Line	:	SUITE 209
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60194-1057
Country	:	US
Telephone Number	:	847-755-3255
Fax Number	:	847-252-7939

Provider Business Practice Location Address
First Line	:	1575 BARRINGTON RD
Second Line	:	SUITE 209
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60194-1057
Country	:	US
Telephone Number	:	847-755-3255
Fax Number	:	847-252-7939

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	10/14/2008

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