MEDICARE: DANTE A. PIMENTEL, M.D., S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician		IL

General Provider Information

NPI Number	:	1720277791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANTE A. PIMENTEL, M.D., S.C.

Provider Business Mailing Address
First Line	:	6032 S HALSTED ST # 102
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-2112
Country	:	US
Telephone Number	:	773-651-9200
Fax Number	:	773-651-9203

Provider Business Practice Location Address
First Line	:	6032 S HALSTED ST # 102
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-2112
Country	:	US
Telephone Number	:	773-651-9200
Fax Number	:	773-651-9203

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANTE ANTHONY PIMENTEL
Credential	:	M.D.
Telephone Number	:	773-651-9200

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	10/16/2007

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