Provider Demographics
NPI:1255337630
Name:PAMPALONE, AJ (DO)
Entity type:Individual
Prefix:
First Name:AJ
Middle Name:
Last Name:PAMPALONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-575-5000
Mailing Address - Fax:
Practice Address - Street 1:2711 LEONARD DR STE 101
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-7121
Practice Address - Country:US
Practice Address - Phone:219-462-6001
Practice Address - Fax:219-462-6060
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002618A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200508390Medicaid
703060SMedicare UPIN
IN703060SMedicare PIN
IN164210PMedicare PIN
IN164220PMedicare PIN