Provider Demographics
NPI:1093827222
Name:PANZICA, PATRICIA MARY (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MARY
Last Name:PANZICA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:MARY
Other - Last Name:KROMELIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5727 STRATHMOOR DR
Mailing Address - Street 2:REAR 1
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5180
Mailing Address - Country:US
Mailing Address - Phone:815-398-1527
Mailing Address - Fax:815-398-1629
Practice Address - Street 1:5727 STRATHMOOR DR
Practice Address - Street 2:REAR 1
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5180
Practice Address - Country:US
Practice Address - Phone:815-398-1527
Practice Address - Fax:815-398-1629
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336017507208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052723Medicaid
IL345480Medicare ID - Type Unspecified
IL036052723Medicaid