Individual
MS. MARIA T PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2003 W FULTON ST STE 303, CHICAGO, IL 60612-2345
(312) 243-2223
Mailing address
2003 W FULTON ST, STE 303, CHICAGO, IL 60612-2345
(618) 662-2191
(618) 662-2191
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-098979
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01616720
BLUE CROSS BLUE SHIELD
IL
05
—
036-098979
—
IL
Enumeration date
01/23/2008
Last updated
01/24/2019
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