Provider Demographics
NPI:1942287230
Name:PALU-AY, PEDRO (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:PALU-AY
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 1:2629 SHERIDAN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-2629
Mailing Address - Country:US
Mailing Address - Phone:847-746-8260
Mailing Address - Fax:847-746-7010
Practice Address - Street 1:2606 ELISHA AVE
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-2608
Practice Address - Country:US
Practice Address - Phone:847-872-4558
Practice Address - Fax:847-872-9334
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36047040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK06660Medicare PIN
ILD11016Medicare UPIN