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General NPI Number Information
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NPI Number | 1851753636
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Entity Type | Organization
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Legal Business Name | PALLAN PRIMARY CARE LTD S C
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 07/09/2018
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Provider Practice Location Address
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Address Line | 2425 W 22ND ST STE 211
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City | OAK BROOK
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State | IL
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Zip | 60523
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Country | US
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Telephone | 630-368-3909
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 428
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-0428
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Country | US
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Telephone | 630-368-3909
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TONY VARGHESE PALLAN
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Credential | M.D.
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Telephone | 913-980-9289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-137215
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License Number State | IL
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