Healthcare Provider Details

I. General information

NPI: 1508904954
Provider Name (Legal Business Name): GEORGE C PANJIKARAN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 E OLYMPIA AVE
PUNTA GORDA FL
33950-3839
US

IV. Provider business mailing address

2400 HARBOR BLVD SUITE #19
PORT CHARLOTTE FL
33952-5038
US

V. Phone/Fax

Practice location:
  • Phone: 941-639-7076
  • Fax:
Mailing address:
  • Phone: 941-625-1391
  • Fax: 941-624-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME34716
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME34716
License Number StateFL

VIII. Authorized Official

Name: GEORGE C PANJIKARAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 941-639-7076