MEDICARE: DR. PANKTI DHRUV REID MD, MPH

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207RR0500X	Rheumatology Physician	036139827	IL

General Provider Information

NPI Number	:	1427491711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PANKTI DHRUV REID MD, MPH

Provider Business Mailing Address
First Line	:	180 HARVESTER DR
Second Line	:	SUITE 110
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-7594
Country	:	US
Telephone Number	:	773-702-1150
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE
Second Line	:	RHEUMATOLOGY DEPARTMENT
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-702-6885
Fax Number	:	773-702-8702

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

Provider Enumeration Date	:	04/17/2013
Last Update Date	:	06/29/2016

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