Provider Demographics
NPI:1316906464
Name:PEREZ, CLARA T (MD)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:T
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:833 W 15TH PL
Mailing Address - Street 2:UNIT 815
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1429
Mailing Address - Country:US
Mailing Address - Phone:708-206-1300
Mailing Address - Fax:708-206-1399
Practice Address - Street 1:1 OLD FRANKFORT WAY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1719
Practice Address - Country:US
Practice Address - Phone:708-206-1300
Practice Address - Fax:708-206-1399
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360674682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL155000OtherPSYCHEALTH PROVIDER #
IL31603879OtherBCBS PROVIDER #
IL018896OtherVALUEOPTIONS PROVIDER #
IL036067468Medicaid
IL31603579OtherBCBS
IL35928OtherAMERICAID PROVIDER #
IL363762147OtherTAX ID #
IL119475OtherCOMPSYCH PROVIDER #
IL166548OtherHARMONY PROVIDER #
IL036067468OtherLICENSE #