Healthcare Provider Details

I. General information

NPI: 1427666866
Provider Name (Legal Business Name): PENDOLINO INTEGRATED MEDICAL AND REHAB CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15715 S ROUTE 59
PLAINFIELD IL
60544-2694
US

IV. Provider business mailing address

15715 S ROUTE 59
PLAINFIELD IL
60544-2694
US

V. Phone/Fax

Practice location:
  • Phone: 630-951-0037
  • Fax:
Mailing address:
  • Phone: 630-951-0037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ANTHONY D PENDOLINO
Title or Position: MANAGING MEMBER
Credential:
Phone: 815-436-1191