Provider Demographics
NPI:1407095821
Name:PITRODA MEDICAL LLC
Entity Type:Organization
Organization Name:PITRODA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:PITRODA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-935-6690
Mailing Address - Street 1:PO BOX 959134
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60195-9134
Mailing Address - Country:US
Mailing Address - Phone:224-353-6361
Mailing Address - Fax:847-278-5398
Practice Address - Street 1:19 E SCHAUMBURG RD FL 2
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3503
Practice Address - Country:US
Practice Address - Phone:224-353-6361
Practice Address - Fax:847-278-5398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115162207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115162Medicaid
IL036115162Medicaid
ILIL3712Medicare PIN