Provider Demographics
NPI:1467667659
Name:FOREFRONT ADULT & PEDIATRIC CARE
Entity type:Organization
Organization Name:FOREFRONT ADULT & PEDIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PANZICA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-485-8380
Mailing Address - Street 1:1938 E LINCOLN HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3927
Mailing Address - Country:US
Mailing Address - Phone:815-485-8380
Mailing Address - Fax:815-485-1116
Practice Address - Street 1:1938 E LINCOLN HWY STE 106
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-3927
Practice Address - Country:US
Practice Address - Phone:815-485-8380
Practice Address - Fax:815-485-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-618128261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095398Medicaid
IL036095398Medicaid