Provider Demographics
NPI:1710090550
Name:PANNU, KULBIR S (MD)
Entity Type:Individual
Prefix:
First Name:KULBIR
Middle Name:S
Last Name:PANNU
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 1:4750 N FEDERAL HWY STE 202
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4609
Mailing Address - Country:US
Mailing Address - Phone:954-368-9773
Mailing Address - Fax:954-530-9754
Practice Address - Street 1:4750 N FEDERAL HWY STE 202
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4609
Practice Address - Country:US
Practice Address - Phone:954-368-9773
Practice Address - Fax:954-530-9754
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91640207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0596878Medicaid
A16420Medicare UPIN
OHPA0582683Medicare ID - Type Unspecified