Provider Demographics
NPI:1689637639
Name:DAGO, PEDRO (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:
Last Name:DAGO
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 1:446 EAST ONTARIO
Mailing Address - Street 2:SUITE 7-100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-695-2608
Mailing Address - Fax:312-695-5010
Practice Address - Street 1:446 E ONTARIO ST
Practice Address - Street 2:SUITE #7-100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4418
Practice Address - Country:US
Practice Address - Phone:312-695-2608
Practice Address - Fax:312-695-5010
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360953722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F85171Medicare UPIN