Provider Demographics
NPI:1437461225
Name:MILLER PANKRATZ, MEGAN M (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:MILLER PANKRATZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5501
Mailing Address - Street 2:222 N 7TH STREET
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58506-5501
Mailing Address - Country:US
Mailing Address - Phone:701-323-6969
Mailing Address - Fax:701-323-5709
Practice Address - Street 1:414 N 7TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4423
Practice Address - Country:US
Practice Address - Phone:701-323-8213
Practice Address - Fax:701-323-5709
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301096375207V00000X
ND13171207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND81065Medicaid