Individual
M PANNIR SELVAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
946 W 79TH STREET, CHICAGO, IL 60620
(773) 723-8501
(773) 723-3578
Mailing address
946 W 79TH STREET, CHICAGO, IL 60620
(773) 723-8501
(773) 723-3578
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036065767
IL
207R00000X
Internal Medicine Physician
36065767
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036065767
—
IL
Enumeration date
08/23/2006
Last updated
02/20/2017
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