Organization
IBSEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAFAEL PEREZ-GUERRA MD (PRESIDENT)
(815) 744-2344
Entity
Organization
Contact information
Practice address
16003 EXECUTIVE DR, CREST HILL, IL 60403-0500
(815) 744-2344
Mailing address
16003 EXECUTIVE DR, CREST HILL, IL 60403-0500
(815) 744-2344
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
036057264
IL
207QB0002X
Obesity Medicine (Family Medicine) Physician
036057264
IL
208D00000X
General Practice Physician
Primary
036057264
IL
Other
Enumeration date
07/01/2013
Last updated
07/01/2013
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