Basic Information
| Provider Information | |||||||||
| NPI: | 1578521902 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PALUTSIS | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | STANLEY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1730 PARK ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605632688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307180200 | ||||||||
| FaxNumber: | 6307180900 | ||||||||
| Practice Location | |||||||||
| Address1: | 4413 ROOSEVELT RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | HILLSIDE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601622074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084490741 | ||||||||
| FaxNumber: | 7084490994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 03/02/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036062738 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036062738 | 05 | IL | MEDICAID |