Provider Demographics
NPI:1073567541
Name:HORIZON DANTE PIMENTEL
Entity Type:Organization
Organization Name:HORIZON DANTE PIMENTEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIMENTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-736-4444
Mailing Address - Street 1:4402 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2511
Mailing Address - Country:US
Mailing Address - Phone:773-736-4444
Mailing Address - Fax:773-283-4849
Practice Address - Street 1:4402 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2511
Practice Address - Country:US
Practice Address - Phone:773-736-4444
Practice Address - Fax:773-283-4849
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCTOR DANTE PIMENTEL LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-20
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111599261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI16106Medicare UPIN
ILK14952Medicare ID - Type Unspecified
IL036111599Medicare ID - Type Unspecified