Healthcare Provider Details

I. General information

NPI: 1720470115
Provider Name (Legal Business Name): CHICAGO PULMONARY AND SLEEP DISORDERS INSTITUTE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1742 S LA LONDE AVE
LOMBARD IL
60148-3537
US

IV. Provider business mailing address

1742 S LA LONDE AVE
LOMBARD IL
60148-3537
US

V. Phone/Fax

Practice location:
  • Phone: 630-338-9366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036087837
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number036087837
License Number StateIL

VIII. Authorized Official

Name: JACEK H PIETA
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 630-338-9366