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Individual

DR. PANNA U GOSWAMI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1604 VISA DR STE 1, NORMAL, IL 61761-2195
(815) 846-4716
(309) 323-0442
Mailing address
1604 VISA DR STE 1, NORMAL, IL 61761-2195
(815) 762-2535
(815) 758-5144

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
036061013
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036-061013
IL
Enumeration date
09/12/2005
Last updated
06/01/2023
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