Provider Demographics
NPI:1174523591
Name:PANJE, WILLIAM R (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:PANJE
Suffix:
Gender:M
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:PO BOX 75803
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-5803
Mailing Address - Country:US
Mailing Address - Phone:708-747-5850
Mailing Address - Fax:708-747-9991
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 340
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-563-9805
Practice Address - Fax:312-563-0165
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036047409207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001629253OtherBLUE CROSS BLUE SHIELD
ILP00281941Medicare PIN
ILC39201Medicare UPIN
ILK21627Medicare PIN
IL040017936Medicare PIN
IL204857Medicare PIN
ILIL1859001Medicare PIN
ILK21628Medicare PIN
IL204869Medicare PIN
ILCC3183Medicare PIN
IL501100Medicare PIN
ILIL1859Medicare PIN
IL040017937Medicare PIN
IL212417Medicare PIN