Provider Demographics
NPI:1720277791
Name:DANTE A. PIMENTEL, M.D., S.C.
Entity Type:Organization
Organization Name:DANTE A. PIMENTEL, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PIMENTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-651-9200
Mailing Address - Street 1:6032 S HALSTED ST # 102
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-2112
Mailing Address - Country:US
Mailing Address - Phone:773-651-9200
Mailing Address - Fax:773-651-9203
Practice Address - Street 1:6032 S HALSTED ST # 102
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211054Medicare PIN