Provider Demographics
NPI:1437326998
Name:ITALO D. PIERI, SC
Entity Type:Organization
Organization Name:ITALO D. PIERI, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ITALO
Authorized Official - Middle Name:D
Authorized Official - Last Name:PIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-763-3808
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:SUITE 415
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-763-3808
Mailing Address - Fax:773-774-5739
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE 415
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-763-3808
Practice Address - Fax:773-774-5739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058671207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058671Medicaid
IL036058671Medicaid
994460Medicare PIN