Healthcare Provider Details

I. General information

NPI: 1528068970
Provider Name (Legal Business Name): PATRICIA PANELLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GORE RD
MORRIS IL
60450-9466
US

IV. Provider business mailing address

725 SCHOOL ST STE A
MORRIS IL
60450-1207
US

V. Phone/Fax

Practice location:
  • Phone: 815-364-8919
  • Fax:
Mailing address:
  • Phone: 815-942-2932
  • Fax: 815-941-4363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036090961
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: