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General NPI Number Information
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NPI Number | 1295802882
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Entity Type | Individual
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Provider Name | PAUL ANTONY PANZICA M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 19621 LA GRANGE RD
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City | MOKENA
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State | IL
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Zip | 60448-9360
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Country | US
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Telephone | 708-478-8380
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Fax | 708-478-3036
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Provider Business Mailing Address
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Address Line | 19621 S LA GRANGE RD
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City | MOKENA
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State | IL
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Zip | 60448-9360
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Country | US
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Telephone | 708-478-8380
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Fax | 708-478-3036
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036095398
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036095398
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License Number State | IL
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