Basic Information
Provider Information
NPI: 1124374509
EntityType: 2
ReplacementNPI:  
OrganizationName: PAC SPECIALISTS, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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Mailing Information
Address1: 4250 N MARINE DR
Address2: SUITE 236
City: CHICAGO
State: IL
PostalCode: 606131744
CountryCode: US
TelephoneNumber: 7734040160
FaxNumber:  
Practice Location
Address1: 1460 N HALSTED ST
Address2: SUITE 202
City: CHICAGO
State: IL
PostalCode: 606422605
CountryCode: US
TelephoneNumber: 7732060412
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/03/2012
LastUpdateDate: 08/03/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: PERLMUTER
AuthorizedOfficialFirstName: ROBERT
AuthorizedOfficialMiddleName: G
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 7732060412
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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