Provider Demographics
NPI:1437112810
Name:PANCHAL, SUNIL J (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNIL
Middle Name:J
Last Name:PANCHAL
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 1:4911 VAN DYKE ROAD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-4813
Mailing Address - Country:US
Mailing Address - Phone:813-264-7246
Mailing Address - Fax:813-264-7249
Practice Address - Street 1:4911 VAN DYKE ROAD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-4813
Practice Address - Country:US
Practice Address - Phone:813-264-7246
Practice Address - Fax:813-264-7249
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93346207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
289384OtherAVMED
78950OtherBCBS
289384OtherAVMED
F94017Medicare UPIN