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NPI Code Detail

MEDICARE: ERIC PAN

MEDICARE: ERIC PAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
22084P0800XPsychiatry Physician036176375IL

General Provider Information

NPI Number : 1669174934
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC PAN
Provider Business Mailing Address
First Line : 251 E HURON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2908
Country : US
Telephone Number : 312-926-2000
Fax Number : 763-402-7531
Provider Business Practice Location Address
First Line : 251 E HURON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2908
Country : US
Telephone Number : 312-926-2000
Fax Number : 763-402-7531
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2023
Last Update Date : 12/05/2025

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Directions to “ ERIC PAN ” Practice Location

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