Basic Information
| Provider Information | |||||||||
| NPI: | 1194043315 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANKOW | ||||||||
| FirstName: | NIKOLAUS | ||||||||
| MiddleName: | WIM | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 253 COURTNEY LAKES CIR | ||||||||
| Address2: | APT 202 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334012377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617983030 | ||||||||
| FaxNumber: | 5617988242 | ||||||||
| Practice Location | |||||||||
| Address1: | 1037 S STATE ROAD 7 | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334146138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617983030 | ||||||||
| FaxNumber: | 5617988242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2010 | ||||||||
| LastUpdateDate: | 05/19/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME121008 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.