Provider Demographics
NPI:1689638090
Name:PANKIEWICZ, IRENA (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENA
Middle Name:
Last Name:PANKIEWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15200 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 395
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3845
Mailing Address - Country:US
Mailing Address - Phone:281-937-7653
Mailing Address - Fax:281-937-7062
Practice Address - Street 1:15200 SOUTHWEST FWY
Practice Address - Street 2:SUITE 395
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3845
Practice Address - Country:US
Practice Address - Phone:281-937-7653
Practice Address - Fax:281-937-7062
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK16072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX344564YZZVMedicare PIN
TX130014571OtherRAILROAD GBA - RAILROAD MEDICARE
TXP01090526OtherRAILROAD MEDICARE PTAN
TX104877901Medicaid
TXMDK1607TXOtherWORKERS COMPENSATION
TX104877906Medicaid
TXTXB150803Medicare PIN
TX85Z657OtherBC/BS TX#
TXG29885Medicare UPIN
TX8DE543OtherBC/BS #