Provider Demographics
NPI:1699940361
Name:BATEMAN, PANTILA VANICHAKARN (MD)
Entity type:Individual
Prefix:DR
First Name:PANTILA
Middle Name:VANICHAKARN
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-4959
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:350 SURRYSE RD STE 100
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-3217
Practice Address - Country:US
Practice Address - Phone:815-206-5700
Practice Address - Fax:847-382-1771
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226001207R00000X
NH15273207RC0000X
IN01075398A207RC0000X
IL036161785207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201313450Medicaid
IN264910084Medicare PIN
IN264430406Medicare PIN
IN183380020Medicare PIN