Provider Demographics
NPI:1669416756
Name:PIELET, BRUCE WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WILLIAM
Last Name:PIELET
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 1:1875 DEMPSTER ST
Mailing Address - Street 2:SUITE 325
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1186
Mailing Address - Country:US
Mailing Address - Phone:847-723-6985
Mailing Address - Fax:847-723-2290
Practice Address - Street 1:1875 DEMPSTER ST
Practice Address - Street 2:SUITE 325
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:847-723-6985
Practice Address - Fax:847-723-2290
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-065054207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC48924Medicare UPIN