Provider Demographics
NPI:1417165705
Name:PANTECK, ALAN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:LEE
Last Name:PANTECK
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 1:17390 SAWGRASS CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-7500
Mailing Address - Country:US
Mailing Address - Phone:440-289-7651
Mailing Address - Fax:
Practice Address - Street 1:1 INFINITY CORPORATE CENTRE DR STE 160
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-5374
Practice Address - Country:US
Practice Address - Phone:216-581-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089224207X00000X
OH89224207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2893418Medicaid