Organization Name: | FOREFRONT ADULT & PEDIATRIC CARE, S.C. |
NPI Number: | 1073762555 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PAUL A. PANZICA (PHYSICIAN/OWNER) |
Mailing Address: | 19621 La Grange Rd Mokena |
State: | IL US |
Postal Code: | 604489360 |
Phone Number: | 7084788380 |
Fax Number: | 7084783036 |
NPI Enumeration Date: | 09/09/2008 |
NPI Last Update Date: | 01/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 036103015 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |