Provider Demographics
NPI:1073762555
Name:FOREFRONT ADULT & PEDIATRIC CARE, S.C.
Entity Type:Organization
Organization Name:FOREFRONT ADULT & PEDIATRIC CARE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PANZICA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-478-8380
Mailing Address - Street 1:19621 LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-9360
Mailing Address - Country:US
Mailing Address - Phone:708-478-8380
Mailing Address - Fax:708-478-3036
Practice Address - Street 1:19621 LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9360
Practice Address - Country:US
Practice Address - Phone:708-478-8380
Practice Address - Fax:708-478-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095398261QP2300X
IL036103015261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095398Medicaid
IL036095398Medicaid