Provider Demographics
NPI:1174516520
Name:PIEL, IRA J (MD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:J
Last Name:PIEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1425 N HUNT CLUB RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2632
Mailing Address - Country:US
Mailing Address - Phone:847-855-9400
Mailing Address - Fax:847-855-9500
Practice Address - Street 1:1425 N HUNT CLUB RD
Practice Address - Street 2:SUITE 301
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2632
Practice Address - Country:US
Practice Address - Phone:847-855-9400
Practice Address - Fax:847-855-9500
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2009-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036043775207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043775Medicaid
IL211888Medicare ID - Type Unspecified
IL036043775Medicaid