MEDICARE: DR. AMRITPAL S PANNU MD

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
1	207R00000X	Internal Medicine Physician	A62711	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1306837927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMRITPAL S PANNU MD

Provider Business Mailing Address
First Line	:	2339 W CLEVELAND AVE
Second Line	:	#103
City	:	MADERA
State	:	CA
Zip	:	93637-8764
Country	:	US
Telephone Number	:	559-673-8055
Fax Number	:	559-673-0389

Provider Business Practice Location Address
First Line	:	2339 CLEVELAND AVE
Second Line	:	#101
City	:	MADERA
State	:	CA
Zip	:	93637
Country	:	US
Telephone Number	:	559-673-8055
Fax Number	:	559-673-0389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	01/27/2010

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