Healthcare Provider Details

I. General information

NPI: 1407098544
Provider Name (Legal Business Name): WILLIAM PANJE MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6703 159TH ST
TINLEY PARK IL
60477-1781
US

IV. Provider business mailing address

PO BOX 1180
MATTESON IL
60443-4180
US

V. Phone/Fax

Practice location:
  • Phone: 708-798-6800
  • Fax:
Mailing address:
  • Phone: 708-747-5850
  • Fax: 708-747-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number036047409
License Number StateIL

VIII. Authorized Official

Name: WILLIAM PANJE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-798-6800