Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 019-022207 | IL |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 019-022207 | IL |
NPI | 1538214234 |
---|---|
Provider Name | Dr. George S. Panos |
First Address | Chicago, IL 60612-3714 |
Second Address | Oak Brook, IL 60523-1277 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 28/04/2021 |