Provider Demographics
NPI:1285761312
Name:LEWIS-PERRY, RITA MARIA (MD)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:MARIA
Last Name:LEWIS-PERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16760 CARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-4612
Mailing Address - Country:US
Mailing Address - Phone:708-895-1701
Mailing Address - Fax:708-418-0620
Practice Address - Street 1:16233 WAUSAU AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2157
Practice Address - Country:US
Practice Address - Phone:708-296-1759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044247A2084P0800X
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1605754OtherBLUE CROSS BLUE SHIELD
ILF41320Medicare UPIN
IL351060Medicare ID - Type Unspecified