Individual
MAMTA PANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
836 W WELLINGTON AVE, CHICAGO, IL 60657-5147
(847) 572-9814
Mailing address
836 W WELLINGTON AVE DEPT OF, CHICAGO, IL 60657-5147
(847) 572-9814
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036.147015
IL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
63133-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669763983
—
WI
Enumeration date
04/20/2011
Last updated
12/23/2021
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