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General NPI Number Information
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NPI Number | 1396091062
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Entity Type | Individual
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Provider Name | MANJINDER PANNU M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 44405 WOODWARD AVE
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City | PONTIAC
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State | MI
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Zip | 48341-5023
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Country | US
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Telephone | 248-858-6233
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Fax |
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Provider Business Mailing Address
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Address Line | 400 NW 1ST AVE APT 4400
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City | MIAMI
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State | FL
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Zip | 33128-1885
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Country | US
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Telephone | 248-636-9306
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD491456C
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | M-12780
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License Number State | ID
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