Healthcare Provider Details

I. General information

NPI: 1467031088
Provider Name (Legal Business Name): ELIZABETH PANKOW DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6145 N THESTA ST
FRESNO CA
93710-5266
US

IV. Provider business mailing address

90 SAINT MARKS PL APT 4C
STATEN ISLAND NY
10301-1662
US

V. Phone/Fax

Practice location:
  • Phone: 559-436-4820
  • Fax:
Mailing address:
  • Phone: 503-936-1988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number007419
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: