1427289917 NPI number — JOSE DANIEL PEREZ PORCEL MD

Table of content: JOSE DANIEL PEREZ PORCEL MD (NPI 1427289917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427289917 NPI number — JOSE DANIEL PEREZ PORCEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ PORCEL
Provider First Name:
JOSE
Provider Middle Name:
DANIEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PEREZ
Provider Other First Name:
JOSE
Provider Other Middle Name:
DANIEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1427289917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
856 W NELSON ST APT 1905
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60657-9204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-313-5281
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
836 W WELLINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60657-5147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-296-5944
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X , with the licence number:  2019043910 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 125057009 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)