MEDICARE: DR. IRENA PANKIEWICZ 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	2084N0400X	Neurology Physician	K1607	TX

General Provider Information

NPI Number	:	1689638090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRENA PANKIEWICZ MD

Provider Business Mailing Address
First Line	:	15200 SOUTHWEST FWY
Second Line	:	SUITE 395
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3845
Country	:	US
Telephone Number	:	281-937-7653
Fax Number	:	281-937-7062

Provider Business Practice Location Address
First Line	:	15200 SOUTHWEST FWY
Second Line	:	SUITE 395
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3845
Country	:	US
Telephone Number	:	281-937-7653
Fax Number	:	281-937-7062

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	05/20/2015

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