MEDICARE: KRISTINE PANIK

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	2084P0800X	Psychiatry Physician	A54593	CA

General Provider Information

NPI Number	:	1760546113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE PANIK

Provider Business Mailing Address
First Line	:	2428 DWIGHT WAY STE 5
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94704-3503
Country	:	US
Telephone Number	:	510-845-5155
Fax Number	:	510-845-5155

Provider Business Practice Location Address
First Line	:	2428 DWIGHT WAY STE 5
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94704-3503
Country	:	US
Telephone Number	:	510-845-5155
Fax Number	:	510-845-5155

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	11/27/2007

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Directions to “ KRISTINE PANIK ” Practice Location

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