Provider Demographics
NPI:1578099347
Name:PANAGAKIS, DIMITRA (APN)
Entity Type:Individual
Prefix:
First Name:DIMITRA
Middle Name:
Last Name:PANAGAKIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20836 N BUFFALO RUN
Mailing Address - Street 2:
Mailing Address - City:KILDEER
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8532
Mailing Address - Country:US
Mailing Address - Phone:847-372-0614
Mailing Address - Fax:
Practice Address - Street 1:20836 N BUFFALO RUN
Practice Address - Street 2:
Practice Address - City:KILDEER
Practice Address - State:IL
Practice Address - Zip Code:60047-8532
Practice Address - Country:US
Practice Address - Phone:847-372-0614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily