Provider Demographics
NPI:1942512827
Name:PALLAN, TONY VARGHESE (MD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:VARGHESE
Last Name:PALLAN
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 1:2000 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7222
Mailing Address - Country:US
Mailing Address - Phone:630-978-6200
Mailing Address - Fax:
Practice Address - Street 1:2000 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7222
Practice Address - Country:US
Practice Address - Phone:630-978-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010015021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQZZ000000044776OtherAETNA BETTER HEALTH
IL12569529OtherCAQH
IL036137215Medicaid
ILQZZ000000044776OtherAETNA BETTER HEALTH
ILF400319603Medicare PIN