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General NPI Number Information
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NPI Number | 1790158186
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Entity Type | Individual
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Provider Name | SUBY ABY PANICHIKUDIYIL NP
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Gender | Female
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Dates
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Enumeration Date | 11/06/2015
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 2100 CLEARWATER DR STE 100
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City | OAK BROOK
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State | IL
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Zip | 60523-1931
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Country | US
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Telephone | 630-607-1000
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Fax | 630-607-1002
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Provider Business Mailing Address
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Address Line | 4131 W LOOMIS RD SUITE 300
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City | GREENFIELD
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State | WI
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Zip | 53221-2057
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Country | US
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Telephone | 414-325-7246
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Fax | 414-325-3770
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209028978
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License Number State | IL
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