=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215021027
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR SILVIA PANITCH LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 01/29/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3344 N ASHLAND AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60657-2109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-525-6595
-----------------------------------------------------
Fax | 773-525-6596
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7434 LOWELL AVE
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60076-3830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-675-5231
-----------------------------------------------------
Fax | 847-675-5231
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT / MEDICAL DIRECTOR
-----------------------------------------------------
Name | SILVIA PANITCH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 773-525-6595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 036063863
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------