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NPI Code Detail

MEDICARE: JOLANTA PENTALA MD

MEDICARE: JOLANTA PENTALA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician49541WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20-604-031-5OTHERECFMG

General Provider Information

NPI Number : 1174535512
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOLANTA PENTALA MD
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number : 800-326-2250
Fax Number :
Provider Business Practice Location Address
First Line : 4025 N 92ND ST
Second Line :
City : WAUWATOSA
State : WI
Zip : 53222-1613
Country : US
Telephone Number : 414-358-5420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2006
Last Update Date : 10/23/2025

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Directions to “ JOLANTA PENTALA MD” Practice Location

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