MEDICARE: DR. JOSEPH S. PANELLA 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	2085R0202X	Diagnostic Radiology Physician		IL

General Provider Information

NPI Number	:	1346286242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH S. PANELLA MD

Provider Business Mailing Address
First Line	:	2100 PFINGSTEN RD
Second Line	:	DEPARTMENT OF RADIOLOGY
City	:	GLENVIEW
State	:	IL
Zip	:	60026-1301
Country	:	US
Telephone Number	:	847-657-3634
Fax Number	:	847-832-6112

Provider Business Practice Location Address
First Line	:	2100 PFINGSTEN RD
Second Line	:	DEPARTMENT OF RADIOLOGY
City	:	GLENVIEW
State	:	IL
Zip	:	60026-1301
Country	:	US
Telephone Number	:	847-657-3634
Fax Number	:	847-832-6112

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	07/08/2007

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