Individual
DR. PIM JETANALIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1801 W TAYLOR ST, CHICAGO, IL 60612-4795
(312) 413-9310
(816) 404-5014
Mailing address
818 S WOLCOTT AVE STE 6, CHICAGO, IL 60612-3704
(312) 413-9310
(816) 404-5014
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
036153543
IL
207RR0500X
Rheumatology Physician
2012006518
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/15/2007
Last updated
06/17/2022
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