MEDICARE: DR. ROBERT MICHAEL PERRIE DDS MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry		IL

General Provider Information

NPI Number	:	1790842250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT MICHAEL PERRIE DDS MS

Provider Business Mailing Address
First Line	:	2835 N SHEFFIELD AVE
Second Line	:	SUITE 405
City	:	CHICAGO
State	:	IL
Zip	:	60657-5084
Country	:	US
Telephone Number	:	773-281-1010
Fax Number	:	773-281-0803

Provider Business Practice Location Address
First Line	:	2835 N SHEFFIELD AVE
Second Line	:	SUITE 405
City	:	CHICAGO
State	:	IL
Zip	:	60657-5084
Country	:	US
Telephone Number	:	773-281-1010
Fax Number	:	773-281-0803

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/08/2007

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