Healthcare Provider Details

I. General information

NPI: 1336376698
Provider Name (Legal Business Name): MANISH KRISHNA PANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2009
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KK RIVER PKWY SUITE 930
MILWAUKEE WI
53215-3669
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-5111
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number64849
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: