Provider Demographics
NPI:1508938507
Name:PALES, ERIC JASON (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JASON
Last Name:PALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1550 N NORTHWEST HWY
Mailing Address - Street 2:SUITE 211
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1411
Mailing Address - Country:US
Mailing Address - Phone:847-768-9300
Mailing Address - Fax:847-768-9393
Practice Address - Street 1:1550 N NORTHWEST HWY
Practice Address - Street 2:SUITE 211
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1411
Practice Address - Country:US
Practice Address - Phone:847-768-9300
Practice Address - Fax:847-768-9393
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-097368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG75767Medicare UPIN