Individual
KERRY P PANOZZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4110 BLACKHAWK RD STE 2, ROCK ISLAND, IL 61201-7039
(309) 428-7055
(309) 265-0118
Mailing address
4110 BLACKHAWK RD STE 2, ROCK ISLAND, IL 61201-7039
(309) 428-7055
(309) 265-0118
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
036090677
IL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
036090677
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036090677
—
IL
Enumeration date
01/11/2006
Last updated
05/29/2015
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