Provider Demographics
NPI:1245421445
Name:PANUTICH, MICHAEL SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:PANUTICH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:415 OLD NEWPORT BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663
Mailing Address - Country:US
Mailing Address - Phone:949-548-9611
Mailing Address - Fax:949-548-9958
Practice Address - Street 1:415 OLD NEWPORT BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663
Practice Address - Country:US
Practice Address - Phone:949-548-9611
Practice Address - Fax:949-548-9958
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2020-02-18
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Provider Licenses
StateLicense IDTaxonomies
CAA96372207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease