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NPI Code Detail

MEDICARE: TOM R PANKRATZ CRNA

MEDICARE: TOM R PANKRATZ CRNA
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
1367500000XCertified Registered Nurse Anesthetist042315WI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4430054481OTHERWIRR MEDICARE PROV #

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11009390OTHERWIPHYS PLUS PROV #
2551896OTHERWIDEANCARE PROV #
3388407992OTHERWITRICARE PROV #
5391023846OTHERWICOMMERCIAL INS PROV #
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699757492
Entity Type Code : Individual
Provider Name (Legal Business Name) : TOM R PANKRATZ CRNA
Provider Business Mailing Address
First Line : 707 14TH ST
Second Line :
City : BARABOO
State : WI
Zip : 53913-1539
Country : US
Telephone Number : 608-356-1400
Fax Number :
Provider Business Practice Location Address
First Line : 707 14TH ST
Second Line :
City : BARABOO
State : WI
Zip : 53913-1539
Country : US
Telephone Number : 608-356-1400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2005
Last Update Date : 03/09/2010

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Directions to “ TOM R PANKRATZ CRNA” Practice Location

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