Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 036104061 | IL |
NPI | 1003885005 |
---|---|
Provider Name | Dr. Gaetano Fernando Perego |
First Address | Chicago, IL 60616-1321 |
Second Address | Chicago, IL 60608-4511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 10/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
213864 | (02) | IL |