Provider Demographics
NPI:1073560546
Name:JALAJA V PISKA,MD,LTD
Entity Type:Organization
Organization Name:JALAJA V PISKA,MD,LTD
Other - Org Name:ADVANCED PAIN SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JALAJA
Authorized Official - Middle Name:VENUGOPAL
Authorized Official - Last Name:PISKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-806-0400
Mailing Address - Street 1:10095 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1272
Mailing Address - Country:US
Mailing Address - Phone:815-806-0400
Mailing Address - Fax:815-806-0406
Practice Address - Street 1:10095 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423
Practice Address - Country:US
Practice Address - Phone:815-806-0400
Practice Address - Fax:815-806-0406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207LP2900X
IL036-104071207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200409690Medicaid
IN200409690Medicaid
IN198860BMedicare ID - Type Unspecified
IL213680Medicare PIN