Provider Demographics
NPI:1427644145
Name:PEROZZI, MARIA (PA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:PEROZZI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16045 108TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5345
Mailing Address - Country:US
Mailing Address - Phone:708-981-3901
Mailing Address - Fax:
Practice Address - Street 1:16045 108TH AVE STE C
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5345
Practice Address - Country:US
Practice Address - Phone:708-981-3901
Practice Address - Fax:708-981-3912
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.008080363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant