Basic Information
| Provider Information | |||||||||
| NPI: | 1568420172 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANAGAS | ||||||||
| FirstName: | ROSEMARIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 911 N ELM ST | ||||||||
| Address2: | SUITE 123 | ||||||||
| City: | HINSDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605213634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308566865 | ||||||||
| FaxNumber: | 6308566813 | ||||||||
| Practice Location | |||||||||
| Address1: | 911 N ELM ST | ||||||||
| Address2: | SUITE 123 | ||||||||
| City: | HINSDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605213634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303255709 | ||||||||
| FaxNumber: | 6303250388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 03/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 36069089 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036069089 | 05 | IL | MEDICAID |