Provider Demographics
NPI:1659463503
Name:PANCHAL, KANU (MD)
Entity Type:Individual
Prefix:MR
First Name:KANU
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 1:4309 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE B305
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050
Mailing Address - Country:US
Mailing Address - Phone:815-344-0175
Mailing Address - Fax:815-344-0145
Practice Address - Street 1:4309 MEDICAL CENTER DR
Practice Address - Street 2:SUITE B305
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050
Practice Address - Country:US
Practice Address - Phone:815-344-0175
Practice Address - Fax:815-344-0145
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
21609919OtherBCBS
684392Medicare ID - Type Unspecified
21609919OtherBCBS