Basic Information
Provider Information
NPI: 1114979036
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PARA
FirstName: PATRICK
MiddleName: FRANCIS
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1121 LAKE COOK RD
Address2: STE M
City: DEERFIELD
State: IL
PostalCode: 600155234
CountryCode: US
TelephoneNumber: 8479454550
FaxNumber: 8479488103
Practice Location
Address1: 1416C S RANDALL RD
Address2: RANDALL SQUARE SHOPPING CENTER
City: GENEVA
State: IL
PostalCode: 601344682
CountryCode: US
TelephoneNumber: 6302089325
FaxNumber: 6302089326
Other Information
ProviderEnumerationDate: 05/17/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X ILY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


Home