Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 125.078471 | IL |
NPI | 1033793195 |
---|---|
Provider Name | Idanis Perez-Alvarez |
First Address | Chicago, IL 60612 |
Second Address | Chicago, IL 60612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2021 |
Last Update Date | 21/06/2021 |