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General NPI Number Information
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NPI Number | 1649453226
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Entity Type | Organization
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Legal Business Name | BERMING PAN MD INC
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 01/07/2019
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Provider Practice Location Address
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Address Line | 306 OHIO ST
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City | WANATAH
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State | IN
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Zip | 46390-0367
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Country | US
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Telephone | 219-733-2755
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Fax | 219-733-2377
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Provider Business Mailing Address
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Address Line | PO BOX 367
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City | WANATAH
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State | IN
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Zip | 46390-0367
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Country | US
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Telephone | 219-733-2755
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Fax | 219-733-2755
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | CHEN-TSU PAN
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Credential | MD
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Telephone | 702-486-4255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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