Provider Demographics
NPI:1093018285
Name:PACANA, TOMMY (MD)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:
Last Name:PACANA
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 1:1256 WATERFORD DR STE 120
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4518
Mailing Address - Country:US
Mailing Address - Phone:630-499-6688
Mailing Address - Fax:630-499-6689
Practice Address - Street 1:1256 WATERFORD DR
Practice Address - Street 2:SUITE 120
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4510
Practice Address - Country:US
Practice Address - Phone:630-499-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036126831208M00000X
VA0116023346390200000X
IL036.126831207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program