Healthcare Provider Details

I. General information

NPI: 1922315498
Provider Name (Legal Business Name): PIOTR C. AL-JINDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST 5TH FLOOR, DEPARTMENT OF ANESTHESIOLOGY
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

1901 W. HARRISON STREET DEP. OF ANESTHESIOLOGY, 5 TH FLOOR
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-1903
  • Fax: 312-864-9544
Mailing address:
  • Phone: 312-864-1903
  • Fax: 312-864-9544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036121266
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036121266
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: