Provider Demographics
NPI:1174726467
Name:PEDRO G. PALU-AY M.D.S.C.
Entity type:Organization
Organization Name:PEDRO G. PALU-AY M.D.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:LORAIN
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-731-8867
Mailing Address - Street 1:2606 ELISHA AVE
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-2608
Mailing Address - Country:US
Mailing Address - Phone:847-872-4558
Mailing Address - Fax:847-872-2042
Practice Address - Street 1:2606 ELISHA AVE
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-2608
Practice Address - Country:US
Practice Address - Phone:847-872-4558
Practice Address - Fax:847-872-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36047040174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD11016Medicare UPIN
IL208609Medicare PIN