| Forefront Adult & Pediatric Care, S.c. | |
|
19621 La Grange Rd Mokena IL 60448-9360 | |
| (708) 478-8380 | |
| (708) 478-3036 |
| Full Name | Forefront Adult & Pediatric Care, S.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 19621 La Grange Rd, Mokena, Illinois |
| Authorized Official Name and Position | Paul A. Panzica (PHYSICIAN/OWNER) |
| Authorized Official Contact | 7084788380 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Forefront Adult & Pediatric Care, S.c. 19621 La Grange Rd Mokena IL 60448-9360 Ph: (708) 478-8380 | Forefront Adult & Pediatric Care, S.c. 19621 La Grange Rd Mokena IL 60448-9360 Ph: (708) 478-8380 |
| NPI Number | 1073762555 |
|---|---|
| Provider Enumeration Date | 09/09/2008 |
| Last Update Date | 01/12/2012 |
| Medicare PECOS PAC ID | 3577747948 |
|---|---|
| Medicare Enrollment ID | O20110408000320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073762555 | NPI | - | NPPES |
| 036095398 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 036095398 (Illinois) | Primary |
| 261QP2300X | Clinic/center - Primary Care | 036103015 (Illinois) | Secondary |
| Provider Name | Paul Antony Panzica |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295802882 PECOS PAC ID: 4284538851 Enrollment ID: I20031125000242 |
| Provider Name | Sarah E Cupp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073167250 PECOS PAC ID: 3375874142 Enrollment ID: I20191009000165 |
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