Provider Demographics
NPI:1891955159
Name:POLLEX ORTHOPAEDICS PC
Entity Type:Organization
Organization Name:POLLEX ORTHOPAEDICS PC
Other - Org Name:DOUGLAS G PANKRATZ MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:PANKRATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-269-9551
Mailing Address - Street 1:1080 S VAN DYKE RD
Mailing Address - Street 2:STE A
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9635
Mailing Address - Country:US
Mailing Address - Phone:989-269-9551
Mailing Address - Fax:989-269-7051
Practice Address - Street 1:1080 S VAN DYKE RD
Practice Address - Street 2:STE A
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9635
Practice Address - Country:US
Practice Address - Phone:989-269-9551
Practice Address - Fax:989-269-7051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDP042780207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DP042780OtherMI STATE LIC NUMBER
MI1368714Medicaid
MI1368714Medicaid
U72832Medicare UPIN
0284190001Medicare NSC