Provider Demographics
NPI:1114913274
Name:PARDO, LEOPOLDO S III (MD)
Entity type:Individual
Prefix:DR
First Name:LEOPOLDO
Middle Name:S
Last Name:PARDO
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:1667 GOLF COURSE DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-4824
Mailing Address - Country:US
Mailing Address - Phone:618-257-8017
Mailing Address - Fax:618-257-8017
Practice Address - Street 1:1667 GOLF COURSE DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-4824
Practice Address - Country:US
Practice Address - Phone:618-257-8017
Practice Address - Fax:618-257-8017
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036087011208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1114913274Medicaid
IL036087011Medicaid
ILIL3374030Medicare PIN
ILF60219Medicare UPIN