Provider Demographics
NPI:1083641146
Name:PILLER, SIMON JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:JOSEPH
Last Name:PILLER
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 1:13450 S. KEDZIE
Mailing Address - Street 2:
Mailing Address - City:ROBBINS
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:773-238-6352
Mailing Address - Fax:708-293-8110
Practice Address - Street 1:ROBBINS HEALTH CENTER OF COOK COUNTY
Practice Address - Street 2:13450 S. KEDZIE AVE.
Practice Address - City:ROBBINS
Practice Address - State:IL
Practice Address - Zip Code:60472
Practice Address - Country:US
Practice Address - Phone:708-293-8100
Practice Address - Fax:708-293-8131
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-096962208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH06870Medicaid