Provider Demographics
NPI:1942310081
Name:PARKVIEW EAR, NOSE & THROAT CLINIC, S.C.
Entity Type:Organization
Organization Name:PARKVIEW EAR, NOSE & THROAT CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PODZIMEK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:309-347-5946
Mailing Address - Street 1:112 PARK RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-3900
Mailing Address - Country:US
Mailing Address - Phone:309-347-5946
Mailing Address - Fax:309-347-2755
Practice Address - Street 1:112 PARK RIDGE LN
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3900
Practice Address - Country:US
Practice Address - Phone:309-347-5946
Practice Address - Fax:309-347-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9032056OtherBLUE SHEILD PROVIDER #
ILIL101OtherJOHN DEERE
ILK20996Medicare PIN
ILIL101OtherJOHN DEERE
IL212310Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER