Basic Information
| Provider Information | |||||||||
| NPI: | 1932335627 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PANJWANI | ||||||||
| FirstName: | POORNIMA | ||||||||
| MiddleName: | ANIL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 329 REMINGTON BLVD STE 205 | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604405817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038626382 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 329 REMINGTON BLVD STE 205 | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604405817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302261130 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2009 | ||||||||
| LastUpdateDate: | 09/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | 085003291 | IL | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 363AM0700X | 085.003291 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.