Provider Demographics
NPI:1205577871
Name:PERRY, DONOVAN EDWARD
Entity type:Individual
Prefix:
First Name:DONOVAN
Middle Name:EDWARD
Last Name:PERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 848195
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-8195
Mailing Address - Country:US
Mailing Address - Phone:847-627-4920
Mailing Address - Fax:224-220-9345
Practice Address - Street 1:1660 FEEHANVILLE DR STE 450
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-6023
Practice Address - Country:US
Practice Address - Phone:847-750-4856
Practice Address - Fax:224-220-9743
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016006105213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist