Provider Demographics
NPI:1760692347
Name:PANARES, ALAN S
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:S
Last Name:PANARES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60192-4507
Mailing Address - Country:US
Mailing Address - Phone:312-593-0824
Mailing Address - Fax:813-854-2244
Practice Address - Street 1:1245 MALLARD LN
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192
Practice Address - Country:US
Practice Address - Phone:312-593-0824
Practice Address - Fax:813-854-2244
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000082246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01637103OtherBLUE CROSS BLUE SHIELD OF IL