Provider Demographics
NPI:1497741011
Name:PINTO, JUDE CAMILLO (MD)
Entity Type:Individual
Prefix:
First Name:JUDE
Middle Name:CAMILLO
Last Name:PINTO
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 1:248 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:FOX LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60020-1630
Mailing Address - Country:US
Mailing Address - Phone:847-587-6333
Mailing Address - Fax:847-587-4839
Practice Address - Street 1:248 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:FOX LAKE
Practice Address - State:IL
Practice Address - Zip Code:60020-1630
Practice Address - Country:US
Practice Address - Phone:847-587-6333
Practice Address - Fax:847-587-4839
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL20707Medicare UPIN