Provider Demographics
NPI:1629015292
Name:PANCHAL, MRUNAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MRUNAL
Middle Name:
Last Name:PANCHAL
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 1:1301 N PLUM GROVE RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4547
Mailing Address - Country:US
Mailing Address - Phone:847-545-9028
Mailing Address - Fax:847-545-9038
Practice Address - Street 1:1301 N PLUM GROVE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4547
Practice Address - Country:US
Practice Address - Phone:847-545-9028
Practice Address - Fax:847-545-9038
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078876208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
L82089Medicare ID - Type Unspecified
E59893Medicare UPIN
L82085Medicare ID - Type Unspecified
L82088Medicare ID - Type Unspecified
L82088Medicare ID - Type Unspecified