Provider Demographics
NPI:1063065225
Name:PERRONE, MATTEO (MD)
Entity type:Individual
Prefix:
First Name:MATTEO
Middle Name:
Last Name:PERRONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-2231
Mailing Address - Country:US
Mailing Address - Phone:815-972-1000
Mailing Address - Fax:815-972-1093
Practice Address - Street 1:815 MARCHESANO DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61102-3521
Practice Address - Country:US
Practice Address - Phone:779-696-5950
Practice Address - Fax:779-696-5914
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-074678390200000X
IL036-159745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty