Provider Demographics
NPI:1033793195
Name:PEREZ-ALVAREZ, IDANIS
Entity type:Individual
Prefix:
First Name:IDANIS
Middle Name:
Last Name:PEREZ-ALVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 W HARRISON ST
Mailing Address - Street 2:PROFESSIONAL BUILDING-SUITE 425
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-563-3000
Mailing Address - Fax:
Practice Address - Street 1:1275 W HARRISON ST
Practice Address - Street 2:PROFESSIONAL BUILDING-SUITE 425
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-563-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.0784712086S0122X
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program