Provider Demographics
NPI:1053377663
Name:PINTO, JUAN C (MD)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:C
Last Name:PINTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-1856
Mailing Address - Country:US
Mailing Address - Phone:815-726-1665
Mailing Address - Fax:815-726-4870
Practice Address - Street 1:691 COLLINS ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-1856
Practice Address - Country:US
Practice Address - Phone:815-726-1665
Practice Address - Fax:815-726-4870
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101192Medicaid