Healthcare Provider Details

I. General information

NPI: 1013168525
Provider Name (Legal Business Name): PATOULA PANAGOS-BILLIRIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 W CONGRESS PKWY 3 PAVILLION
CHICAGO IL
60612-3833
US

IV. Provider business mailing address

1653 W CONGRESS PKWY 3 PAVILLION
CHICAGO IL
60612-3833
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-3306
  • Fax: 312-942-4370
Mailing address:
  • Phone: 312-942-3306
  • Fax: 312-942-4370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD452115
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number247390
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC10010947
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberC10010947
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD452115
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036-141929
License Number StateIL
# 7
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME147171
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: