MEDICARE: PAUL ANTONY PANZICA M.D.

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	208000000X	Pediatrics Physician	036095398	IL
2	207R00000X	Internal Medicine Physician	036095398	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295802882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL ANTONY PANZICA M.D.

Provider Business Mailing Address
First Line	:	19621 S LA GRANGE RD
Second Line	:
City	:	MOKENA
State	:	IL
Zip	:	60448-9360
Country	:	US
Telephone Number	:	708-478-8380
Fax Number	:	708-478-3036

Provider Business Practice Location Address
First Line	:	19621 LA GRANGE RD
Second Line	:
City	:	MOKENA
State	:	IL
Zip	:	60448-9360
Country	:	US
Telephone Number	:	708-478-8380
Fax Number	:	708-478-3036

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	12/01/2025

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