Healthcare Provider Details

I. General information

NPI: 1740102854
Provider Name (Legal Business Name): SPECIALTY INFUSION PROVIDERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 OAK AVENUE 1744 OAK AVENUE
EVANSTON IL
60201
US

IV. Provider business mailing address

1744 OAK AVENUE 1744 OAK AVENUE
EVANSTON IL
60201
US

V. Phone/Fax

Practice location:
  • Phone: 847-922-6440
  • Fax: 847-922-6440
Mailing address:
  • Phone: 847-922-6440
  • Fax: 847-922-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: ADAM PANFIL
Title or Position: CHIEF OPERATING OFFICER
Credential: COO
Phone: 847-922-6440