MEDICARE: WILLIAM R PANJE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	036047409	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001629253	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1174523591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM R PANJE MD

Provider Business Mailing Address
First Line	:	PO BOX 75803
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60675-5803
Country	:	US
Telephone Number	:	708-747-5850
Fax Number	:	708-747-9991

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST
Second Line	:	SUITE 340
City	:	CHICAGO
State	:	IL
Zip	:	60612-3841
Country	:	US
Telephone Number	:	312-563-9805
Fax Number	:	312-563-0165

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	06/17/2009

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Directions to “ WILLIAM R PANJE MD” Practice Location

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