Healthcare Provider Details

I. General information

NPI: 1750577979
Provider Name (Legal Business Name): PINTO-THOMAS, M.D., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 E GRAND AVE
FOX LAKE IL
60020-1630
US

IV. Provider business mailing address

248 E GRAND AVE
FOX LAKE IL
60020-1630
US

V. Phone/Fax

Practice location:
  • Phone: 847-587-6333
  • Fax: 847-587-4839
Mailing address:
  • Phone: 847-587-6333
  • Fax: 847-587-4839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. JUDE C/ PINTO
Title or Position: SECRETARY
Credential: M.D.
Phone: 847-587-6333