1568456374 NPI number — DR. GERARDO PEREZ- ESPINDOLA DPM

Table of content: DR. GERARDO PEREZ- ESPINDOLA DPM (NPI 1568456374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568456374 NPI number — DR. GERARDO PEREZ- ESPINDOLA DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ- ESPINDOLA
Provider First Name:
GERARDO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PEREZ ESPINDOLA
Provider Other First Name:
GERARDO
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568456374
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
159 N GREENLEAF ST STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GURNEE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60031-3341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-249-3888
Provider Business Mailing Address Fax Number:
847-574-7477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
159 N GREENLEAF ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GURNEE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60031-3341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-886-0000
Provider Business Practice Location Address Fax Number:
847-574-7477
Provider Enumeration Date:
09/07/2005

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: 213ES0103X , with the licence number:  016-005265 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0103X , with the licence number: 911-025 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: WI1874 . This is a "MEDICARE PTAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1568456374 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43241500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016-005265 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: IL4062 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1932454279 . This is a "MEDICARE GROUP NPI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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