Individual
DR. WALTER DANIEL PEREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2859 S PULASKI RD, CHICAGO, IL 60623-4456
(773) 762-3333
(773) 762-5555
Mailing address
625 S CHATHAM AVE, ELMHURST, IL 60126-4046
(630) 359-4553
(630) 359-4552
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036-097752
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01636255
BLUE CROSS BLUE SHIELD IL
IL
05
—
036097752-1
—
IL
05
—
036097752-2
—
IL
01
—
363661051
FEDERAL ID
IL
Enumeration date
08/19/2006
Last updated
02/24/2012
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