MEDICARE: KELVIN S PANESAR 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	2080P0214X	Pediatric Pulmonology Physician	26415	AZ

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	:	1942281654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELVIN S PANESAR MD

Provider Business Mailing Address
First Line	:	PO BOX 9362
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-9362
Country	:	US
Telephone Number	:	480-892-2260
Fax Number	:	480-892-2274

Provider Business Practice Location Address
First Line	:	10250 N 92ND ST
Second Line	:	308
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4510
Country	:	US
Telephone Number	:	480-892-2260
Fax Number	:	480-892-2274

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	03/23/2011

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Directions to “ KELVIN S PANESAR MD” Practice Location

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