Provider Demographics
NPI:1427035815
Name:PISKA, JALAJA V (MD)
Entity Type:Individual
Prefix:DR
First Name:JALAJA
Middle Name:V
Last Name:PISKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10095 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
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-104071207LP2900X
IL036104071207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2044193076012201Medicaid
IL213680OtherMEDICARE
IL213680Medicare PIN