Healthcare Provider Details

I. General information

NPI: 1780665513
Provider Name (Legal Business Name): NANCY L PUTNAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PALOS COMMUNITY HOSPITAL 12251 S. 80TH AVENUE
PALOS HEIGHTS IL
60463
US

IV. Provider business mailing address

7808 W COLLEGE DR 1SE
PALOS HEIGHTS IL
60463-1027
US

V. Phone/Fax

Practice location:
  • Phone: 708-923-4000
  • Fax: 708-448-6350
Mailing address:
  • Phone: 708-448-6300
  • Fax: 708-448-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: