Provider Demographics
NPI:1053596809
Name:PINTO MEDICAL GROUP S.C.
Entity type:Organization
Organization Name:PINTO MEDICAL GROUP S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PINTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-726-1665
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101192261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101192Medicaid
ILH51979Medicare UPIN