Healthcare Provider Details

I. General information

NPI: 1083687016
Provider Name (Legal Business Name): PANOS C ALEXANDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 S REED RD
KOKOMO IN
46902-3828
US

IV. Provider business mailing address

3611 S REED RD
KOKOMO IN
46902-3828
US

V. Phone/Fax

Practice location:
  • Phone: 765-864-5730
  • Fax: 765-864-5731
Mailing address:
  • Phone: 765-864-5730
  • Fax: 765-864-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01033461A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: