Provider Demographics
NPI:1972591527
Name:PIMENTEL, DANTE ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:DANTE
Middle Name:ANTHONY
Last Name:PIMENTEL
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 1:326 W 64TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-3114
Mailing Address - Country:US
Mailing Address - Phone:855-276-5212
Mailing Address - Fax:
Practice Address - Street 1:6032 S HALSTED ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-2112
Practice Address - Country:US
Practice Address - Phone:773-651-9200
Practice Address - Fax:773-651-9203
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111599207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1634551OtherBLUE CROSS BLUE SHIELD
ILP00340190OtherPALMETTO GBA-RAILROAD
IL036111599Medicaid
IL211054OtherMEDICARE GROUP
IL211054OtherMEDICARE GROUP
IL1634551OtherBLUE CROSS BLUE SHIELD