Healthcare Provider Details

I. General information

NPI: 1790158186
Provider Name (Legal Business Name): SUBY ABY PANICHIKUDIYIL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 ROLLINGRIDGE RD STE 201
NAPERVILLE IL
60564-4217
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 630-967-6000
  • Fax: 630-428-3971
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209028978
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-028978
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: