Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036065562 | IL |
N | 208600000X | Surgeon | 036065562 | IL |
N | 2086S0122X | Plastic and Reconstructive Surgery | 036065562 | IL |
Y | 2086X0206X | Surgical Oncologist | 036065562 | IL |
NPI | 1134115231 |
---|---|
Provider Name | Alejandra Perez-Tamayo |
First Address | Chicago, IL 60612-4325 |
Second Address | Chicago, IL 60612-4795 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 13/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020052881 | RAILROAD MEDICARE (01) | IL |
036065562 | (05) | IL |
202351 | BCBS PROVIDER ID (01) | IL |
21622027 | BCBS PROVIDER ID (01) | IL |
D89935 | (02) | IL |
P00129722 | RAILROAD MEDICARE (01) | IL |