Provider Demographics
NPI:1548247794
Name:PANOUSHIS, EUSTATHIA J (MD)
Entity type:Individual
Prefix:DR
First Name:EUSTATHIA
Middle Name:J
Last Name:PANOUSHIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1350 W FULLERTON AVE
Mailing Address - Street 2:#405
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2198
Mailing Address - Country:US
Mailing Address - Phone:773-327-2156
Mailing Address - Fax:
Practice Address - Street 1:201 E HURON ST
Practice Address - Street 2:GALTER AMBULATORY PAVILLION SUITE 12-260
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3197
Practice Address - Country:US
Practice Address - Phone:312-926-9570
Practice Address - Fax:312-926-6776
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics