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General NPI Number Information
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NPI Number | 1285897272
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Entity Type | Individual
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Provider Name | PANKAJ MADAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 21727 IH 10 W STE 103
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City | SAN ANTONIO
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State | TX
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Zip | 78257-2108
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Country | US
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Telephone | 210-644-1230
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Fax | 210-702-4615
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Provider Business Mailing Address
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Address Line | 408 CLIFFSIDE DR
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City | SHAVANO PARK
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State | TX
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Zip | 78231-1513
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Country | US
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Telephone | 206-218-3652
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | Q6873
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License Number State | TX
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