Provider Demographics
NPI:1578653994
Name:PEREZ-GUERRA, RAFAEL A (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:A
Last Name:PEREZ-GUERRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16003 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-0500
Mailing Address - Country:US
Mailing Address - Phone:815-838-9544
Mailing Address - Fax:815-838-9580
Practice Address - Street 1:16003 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-0500
Practice Address - Country:US
Practice Address - Phone:815-838-9544
Practice Address - Fax:815-838-9580
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036057264207QB0002X, 208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery