Healthcare Provider Details

I. General information

NPI: 1073560546
Provider Name (Legal Business Name): JALAJA V PISKA,MD,LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10095 W LINCOLN HWY
FRANKFORT IL
60423
US

IV. Provider business mailing address

10095 W LINCOLN HWY
FRANKFORT IL
60423-1272
US

V. Phone/Fax

Practice location:
  • Phone: 815-806-0400
  • Fax: 815-806-0406
Mailing address:
  • Phone: 815-806-0400
  • Fax: 815-806-0406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JALAJA VENUGOPAL PISKA
Title or Position: PRESIDENT
Credential: M.D
Phone: 815-806-0400