Provider Demographics
NPI:1063409035
Name:PEREZ, FRANK R (PA-C)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:R
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4738 N MAGNOLIA AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4944
Mailing Address - Country:US
Mailing Address - Phone:773-315-6199
Mailing Address - Fax:
Practice Address - Street 1:7000 CERMAK RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2112
Practice Address - Country:US
Practice Address - Phone:708-484-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002396363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ43291Medicare UPIN
ILK17389/208534Medicare ID - Type Unspecified