MEDICARE: STEPHANIE PANKOW D.O.

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	94-08689	KS
2	207RI0200X	Infectious Disease Physician	S6010	TX

General Provider Information

NPI Number	:	1437531126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE PANKOW D.O.

Provider Business Mailing Address
First Line	:	6431 FANNIN ST STE MSB 2112
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:	713-500-6767
Fax Number	:

Provider Business Practice Location Address
First Line	:	6431 FANNIN ST STE MSB 2112
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030
Country	:	US
Telephone Number	:	713-500-6767
Fax Number	:

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

Provider Enumeration Date	:	06/18/2015
Last Update Date	:	07/16/2021

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