Provider Demographics
NPI:1194043315
Name:PANKOW, NIKOLAUS WIM (MD)
Entity Type:Individual
Prefix:MR
First Name:NIKOLAUS
Middle Name:WIM
Last Name:PANKOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:253 COURTNEY LAKES CIR
Mailing Address - Street 2:APT 202
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2377
Mailing Address - Country:US
Mailing Address - Phone:561-798-3030
Mailing Address - Fax:561-798-8242
Practice Address - Street 1:1037 S STATE ROAD 7
Practice Address - Street 2:SUITE 211
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6138
Practice Address - Country:US
Practice Address - Phone:561-798-3030
Practice Address - Fax:561-798-8242
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2016-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME121008207Q00000X
OH35-121972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIL676YMedicare UPIN