Provider Demographics
NPI:1013168525
Name:PANAGOS-BILLIRIS, PATOULA (MD)
Entity Type:Individual
Prefix:DR
First Name:PATOULA
Middle Name:
Last Name:PANAGOS-BILLIRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1653 W CONGRESS PKWY
Mailing Address - Street 2:3 PAVILLION
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3833
Mailing Address - Country:US
Mailing Address - Phone:312-942-3306
Mailing Address - Fax:312-942-4370
Practice Address - Street 1:1653 W CONGRESS PKWY
Practice Address - Street 2:3 PAVILLION
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3833
Practice Address - Country:US
Practice Address - Phone:312-942-3306
Practice Address - Fax:312-942-4370
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD452115208000000X, 2080N0001X
MA247390208000000X
DEC10010947208000000X, 2080N0001X
IL036-1419292080N0001X
FLME1471712080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVXBKLOtherBLUE CROSS BLUE SHIELD
FL108977300Medicaid