Organization
KANU PANCHAL MDSC
Active
Other names
Neuro Spine Center of Northern Illinois SC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KANU PANCHAL MD (OWNER)
(815) 344-0175
Entity
Organization
Contact information
Practice address
4309 W MEDICAL CENTER DR, SUITE B301, MCHENRY, IL 60050-8419
(815) 344-0175
(815) 344-0145
Mailing address
4309 W MEDICAL CENTER DR, SUITE B301, MCHENRY, IL 60050-8419
(815) 344-0175
(815) 344-0145
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036056972
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21609919
BLUE CROSS BLUE SHIELD
IL
Enumeration date
04/04/2007
Last updated
01/03/2012
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