MEDICARE: DR. PANKAJ MADAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	Q6873	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	498304YR99	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8FV105	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1285897272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PANKAJ MADAN MD

Provider Business Mailing Address
First Line	:	408 CLIFFSIDE DR
Second Line	:
City	:	SHAVANO PARK
State	:	TX
Zip	:	78231-1513
Country	:	US
Telephone Number	:	206-218-3652
Fax Number	:

Provider Business Practice Location Address
First Line	:	21727 IH 10 W STE 103
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-2108
Country	:	US
Telephone Number	:	210-644-1230
Fax Number	:	210-702-4615

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	01/24/2023

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