Provider Demographics
NPI:1952486482
Name:PANEK, CHRISTOPHER (DPM)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:PANEK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117
Mailing Address - Country:US
Mailing Address - Phone:724-758-4900
Mailing Address - Fax:724-758-8190
Practice Address - Street 1:601 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117
Practice Address - Country:US
Practice Address - Phone:724-758-4900
Practice Address - Fax:724-758-8190
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004669R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA341984599OtherTAX ID
PA434455OtherBLUE SHIELD
PAP00117002OtherRAILROAD MEDICARE
PAP00117002OtherRAILROAD MEDICARE
PAU80224Medicare UPIN
PA434455OtherBLUE SHIELD