Healthcare Provider Details

I. General information

NPI: 1023778917
Provider Name (Legal Business Name): MS. KRITIKA PANDAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 BUTTERFIELD RD STE 116
DOWNERS GROVE IL
60515-5620
US

IV. Provider business mailing address

6689 DOUBLE EAGLE DR APT 207
WOODRIDGE IL
60517-5423
US

V. Phone/Fax

Practice location:
  • Phone: 708-364-0580
  • Fax: 708-364-0480
Mailing address:
  • Phone: 630-379-7061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: