Provider Demographics
NPI:1083660393
Name:PANKAJ HUKKU, MD PC
Entity Type:Organization
Organization Name:PANKAJ HUKKU, MD PC
Other - Org Name:PULMONARY AND SLEEP DISORDERS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:HUKKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-280-1867
Mailing Address - Street 1:PO BOX 2502
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-2502
Mailing Address - Country:US
Mailing Address - Phone:248-212-6442
Mailing Address - Fax:248-280-0222
Practice Address - Street 1:1380 COOLIDGE HWY STE 110
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7067
Practice Address - Country:US
Practice Address - Phone:248-280-1867
Practice Address - Fax:248-280-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047842207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3235280Medicaid
MIE16083Medicare UPIN
MI0M63060Medicare ID - Type UnspecifiedMEDICARE GROUPNYMBER