Healthcare Provider Details

I. General information

NPI: 1073762555
Provider Name (Legal Business Name): FOREFRONT ADULT & PEDIATRIC CARE, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19621 LA GRANGE RD
MOKENA IL
60448-9360
US

IV. Provider business mailing address

19621 S LA GRANGE RD
MOKENA IL
60448-9360
US

V. Phone/Fax

Practice location:
  • Phone: 708-478-8380
  • Fax: 708-478-3036
Mailing address:
  • Phone: 708-478-8380
  • Fax: 708-478-3036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036095398
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL ANTONY PANZICA
Title or Position: OWNER
Credential: MD
Phone: 708-478-8380