Provider Demographics
NPI:1700844990
Name:TANNA, PANKAJ S (MD)
Entity Type:Individual
Prefix:DR
First Name:PANKAJ
Middle Name:S
Last Name:TANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:333 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8200
Mailing Address - Country:US
Mailing Address - Phone:815-725-6331
Mailing Address - Fax:815-725-4709
Practice Address - Street 1:333 MADISON ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8200
Practice Address - Country:US
Practice Address - Phone:815-725-6331
Practice Address - Fax:815-725-4709
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC37463Medicare UPIN