Provider Demographics
NPI:1528279577
Name:PANICKER, SUMITHA V (MD)
Entity type:Individual
Prefix:
First Name:SUMITHA
Middle Name:V
Last Name:PANICKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUMITHA
Other - Middle Name:S
Other - Last Name:NAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:620 N RIVER RD
Mailing Address - Street 2:STE 102
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8950
Mailing Address - Country:US
Mailing Address - Phone:630-355-4755
Mailing Address - Fax:630-355-8838
Practice Address - Street 1:235 REMINGTON BLVD
Practice Address - Street 2:STE K
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-5826
Practice Address - Country:US
Practice Address - Phone:630-914-5153
Practice Address - Fax:630-914-5157
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125049037207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine