Healthcare Provider Details

I. General information

NPI: 1609372341
Provider Name (Legal Business Name): LLOYD DEVASSY PANJIKARAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MERCY AVE
MERCED CA
95340-8319
US

IV. Provider business mailing address

3665 VENICE AVE
MERCED CA
95348-8404
US

V. Phone/Fax

Practice location:
  • Phone: 209-564-5000
  • Fax:
Mailing address:
  • Phone: 847-284-8288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.155194
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036155194
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA185908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: