Provider Demographics
NPI:1932335627
Name:PANJWANI, POORNIMA ANIL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:POORNIMA
Middle Name:ANIL
Last Name:PANJWANI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 REMINGTON BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-5817
Mailing Address - Country:US
Mailing Address - Phone:503-862-6382
Mailing Address - Fax:
Practice Address - Street 1:329 REMINGTON BLVD STE 205
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-5817
Practice Address - Country:US
Practice Address - Phone:630-226-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003291208VP0014X
IL085.003291363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine