Provider Demographics
NPI:1275828113
Name:PANIKKATH, RAGESH (MD)
Entity Type:Individual
Prefix:
First Name:RAGESH
Middle Name:
Last Name:PANIKKATH
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 1:1941 JOHNSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4154
Mailing Address - Country:US
Mailing Address - Phone:805-782-8844
Mailing Address - Fax:833-613-2634
Practice Address - Street 1:1941 JOHNSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4154
Practice Address - Country:US
Practice Address - Phone:805-782-8844
Practice Address - Fax:805-782-8859
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ59548207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology