Provider Demographics
NPI:1316292592
Name:PANOZZO, STACY (DO)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:
Last Name:PANOZZO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 S IL ROUTE 21 STE 130
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3803
Mailing Address - Country:US
Mailing Address - Phone:847-566-3337
Mailing Address - Fax:847-816-3166
Practice Address - Street 1:731 S IL ROUTE 21 STE 130
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3803
Practice Address - Country:US
Practice Address - Phone:847-566-3337
Practice Address - Fax:847-816-3166
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-060895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine