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NPI Code Detail

MEDICARE: CONSTANTINE PAUL PANAKOS DO

MEDICARE: CONSTANTINE PAUL PANAKOS DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician0530413KS
2207Q00000XFamily Medicine Physician3867IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
171590OTHERBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114949179
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONSTANTINE PAUL PANAKOS DO
Provider Business Mailing Address
First Line : 606 N MULBERRY RD
Second Line : TANGLEWOOD MEDICAL CLINIC, PA
City : DERBY
State : KS
Zip : 67037-3532
Country : US
Telephone Number : 316-788-3787
Fax Number : 316-788-2618
Provider Business Practice Location Address
First Line : 606 N MULBERRY RD
Second Line : TANGLEWOOD MEDICAL CENTER, PA
City : DERBY
State : KS
Zip : 67037-3532
Country : US
Telephone Number : 316-788-3787
Fax Number : 316-788-2618
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 04/06/2015

Similar Medicare Providers

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Practice Location Address:
606 MULBERRY RD
DERBY, KS
67037-3532
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1942275342 — DR. ROGER LYNN THOMAS DO
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1922073337 — DR. GLEN RAY PATTON DO
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1952323842 — KATHERINE JEAN CATES PANAKOS DO
Practice Location Address:
606 N MULBERRY RD
DERBY, KS
67037-3532
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Practice Fax:
1144321902 — MRS. MALISSA KAY PAXTON RPAC
Practice Location Address:
606 MULBERRY RD
DERBY, KS
67037-3532
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1124129911 — MR. EDWIN LYSLE PRICE RPAC
Practice Location Address:
606 MULBERRY RD
DERBY, KS
67037-3532
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Practice Fax: 316-788-6930

Directions to “ CONSTANTINE PAUL PANAKOS DO” Practice Location

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