=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710398664
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEEL PANCHOLI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2014
-----------------------------------------------------
Last Update Date | 06/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 SPALDING DR STE 300
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60540-6553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-790-1872
-----------------------------------------------------
Fax | 630-355-2515
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | POB 7132960
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60677-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-469-9200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | U6046
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 036.153510
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------