Healthcare Provider Details

I. General information

NPI: 1306838214
Provider Name (Legal Business Name): DOUGLAS G PANKRATZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 S VAN DYKE RD STE A
BAD AXE MI
48413-9635
US

IV. Provider business mailing address

1080 S VAN DYKE RD STE A
BAD AXE MI
48413-9635
US

V. Phone/Fax

Practice location:
  • Phone: 989-269-9551
  • Fax: 989-269-7051
Mailing address:
  • Phone: 989-269-9551
  • Fax: 989-269-7051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDP042780
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: