Organization
HENRY T PIMENTEL MDSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HENRY T PIMENTAL M.D. (OWNER)
(773) 651-9200
Entity
Organization
Contact information
Practice address
326 W 64TH ST, CHICAGO, IL 60621-3114
(773) 962-3900
Mailing address
5501 W 79TH ST, SUITE 400, BURBANK, IL 60459-1784
(773) 884-4523
(773) 884-4580
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036041603
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036041603
—
IL
01
—
215344
MEDICARE PTAN
IL
01
—
21623403
BLUE SHIELD
IL
Enumeration date
06/15/2007
Last updated
12/05/2014
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