Provider Demographics
NPI:1518715002
Name:PANICKER INTERNAL MEDICINE INC
Entity type:Organization
Organization Name:PANICKER INTERNAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUMITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-622-1414
Mailing Address - Street 1:1414 S RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-1922
Mailing Address - Country:US
Mailing Address - Phone:630-923-6767
Mailing Address - Fax:630-489-9619
Practice Address - Street 1:1414 S RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-1922
Practice Address - Country:US
Practice Address - Phone:630-923-6767
Practice Address - Fax:630-489-9619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty