Provider Demographics
NPI:1508904954
Name:GEORGE C PANJIKARAN MD PA
Entity Type:Organization
Organization Name:GEORGE C PANJIKARAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PANJIKARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-639-7076
Mailing Address - Street 1:2400 HARBOR BLVD
Mailing Address - Street 2:SUITE #19
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5038
Mailing Address - Country:US
Mailing Address - Phone:941-625-1391
Mailing Address - Fax:941-624-0635
Practice Address - Street 1:603 E OLYMPIA AVE
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3839
Practice Address - Country:US
Practice Address - Phone:941-639-7076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34716207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD51977Medicare UPIN
FL08094AMedicare PIN