Provider Demographics
NPI:1164402194
Name:PANKRATZ, TODD A (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:PANKRATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 N KANSAS AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-2644
Mailing Address - Country:US
Mailing Address - Phone:402-463-6793
Mailing Address - Fax:402-463-6894
Practice Address - Street 1:2115 N KANSAS AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-2644
Practice Address - Country:US
Practice Address - Phone:402-463-6793
Practice Address - Fax:402-463-6894
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20816207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100695OtherBLUE CROSS BLUE SHIELD
NE01484OtherBLUE CROSS BLUE SHIELD
NEG29425Medicare UPIN
KS100695Medicare ID - Type Unspecified
NE270574Medicare ID - Type Unspecified