Provider Demographics
NPI:1316960875
Name:PERRY, ISAIAH J (MD)
Entity type:Individual
Prefix:DR
First Name:ISAIAH
Middle Name:J
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7615 ROOSEVELT RD
Mailing Address - Street 2:APT.1
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-3002
Mailing Address - Country:US
Mailing Address - Phone:708-488-1915
Mailing Address - Fax:
Practice Address - Street 1:5470 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-4031
Practice Address - Country:US
Practice Address - Phone:773-287-7900
Practice Address - Fax:773-287-5923
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036059418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC42519Medicare UPIN