Provider Demographics
NPI:1255446852
Name:PANINE, VLADIMIR V (MD)
Entity type:Individual
Prefix:DR
First Name:VLADIMIR
Middle Name:V
Last Name:PANINE
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 1:875 N MICHIGAN AVE STE 2727
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1822
Mailing Address - Country:US
Mailing Address - Phone:847-856-2600
Mailing Address - Fax:847-574-5887
Practice Address - Street 1:875 N MICHIGAN AVE STE 2727
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1822
Practice Address - Country:US
Practice Address - Phone:847-856-2600
Practice Address - Fax:847-574-5887
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36094089174400000X
IL036094089207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL11208435OtherCAQH