Provider Demographics
NPI:1790016004
Name:PINEDA, JOWELLA REAL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOWELLA
Middle Name:REAL
Last Name:PINEDA
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 1:1941 ROHLWING RD
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1338
Mailing Address - Country:US
Mailing Address - Phone:847-618-0850
Mailing Address - Fax:847-618-0859
Practice Address - Street 1:1941 ROHLWING RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1338
Practice Address - Country:US
Practice Address - Phone:847-618-0850
Practice Address - Fax:847-618-0859
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103257207R00000X
IL036144125207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036144125OtherSTATE LICENSE