Healthcare Provider Details

I. General information

NPI: 1356509947
Provider Name (Legal Business Name): MARK STEVEN PANKONIN M.D./PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 COOPER AVE SUITE 4300
SAGINAW MI
48602-5182
US

IV. Provider business mailing address

1447 N HARRISON ST
SAGINAW MI
48602-4727
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-7460
  • Fax: 989-583-7432
Mailing address:
  • Phone: 989-583-2833
  • Fax: 989-583-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2021-02901
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number295203
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2025045301
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301105873
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: