Basic Information
| Provider Information | |||||||||
| NPI: | 1215974944 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 BUTTERFIELD RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605151050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307252730 | ||||||||
| FaxNumber: | 8442055691 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 BROOKHAVEN AVE NE | ||||||||
| Address2: | SUITE B1180 | ||||||||
| City: | BROOKHAVEN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303193253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047059099 | ||||||||
| FaxNumber: | 4047059094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 202K00000X | 065875 | GA | N | Allopathic & Osteopathic Physicians | Phlebology | 208D00000X | 065875 | GA | N | Allopathic & Osteopathic Physicians | General Practice | 2086S0129X | 065875 | GA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 003191533A | 05 | GA | MEDICAID | 259774800 | 05 | FL | MEDICAID |