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General NPI Number Information
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NPI Number | 1467031088
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Entity Type | Individual
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Provider Name | ELIZABETH PANKOW DPM
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Gender | Female
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 6145 N THESTA ST
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City | FRESNO
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State | CA
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Zip | 93710-5266
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Country | US
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Telephone | 559-436-4820
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Fax |
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Provider Business Mailing Address
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Address Line | 90 SAINT MARKS PL APT 4C
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City | STATEN ISLAND
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State | NY
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Zip | 10301-1662
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Country | US
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Telephone | 503-936-1988
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 007419
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E6104
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License Number State | CA
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