MEDICARE: DR. DANTE ANTHONY PIMENTEL M.D.

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	036111599	IL
2	208M00000X	Hospitalist Physician	036111599	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	211054	OTHER	IL	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1634551	OTHER	IL	BLUE CROSS BLUE SHIELD
2	P00340190	OTHER	IL	PALMETTO GBA-RAILROAD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972591527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANTE ANTHONY PIMENTEL M.D.

Provider Business Mailing Address
First Line	:	326 W 64TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-3114
Country	:	US
Telephone Number	:	855-276-5212
Fax Number	:

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

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	07/22/2022

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Directions to “ DR. DANTE ANTHONY PIMENTEL M.D.” Practice Location

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