Provider Demographics
NPI:1487740734
Name:PEREZ, ALEXANDER C (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:C
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4445 S TALMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-1342
Mailing Address - Country:US
Mailing Address - Phone:773-847-9657
Mailing Address - Fax:
Practice Address - Street 1:150 E PONCE DE LEON AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2543
Practice Address - Country:US
Practice Address - Phone:800-998-5859
Practice Address - Fax:404-378-7460
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360955932085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H65669Medicare UPIN