Provider Demographics
NPI:1013113547
Name:PANAH, VERONIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:VERONIKA
Middle Name:
Last Name:PANAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VERONIKA
Other - Middle Name:
Other - Last Name:KARASEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2920 N CASCADE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6262
Mailing Address - Country:US
Mailing Address - Phone:719-696-1201
Mailing Address - Fax:719-696-1326
Practice Address - Street 1:2010 16TH ST STE A
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5188
Practice Address - Country:US
Practice Address - Phone:970-810-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0062745207R00000X, 207RG0100X
AZ81342207R00000X
TXP6432207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX289265YR9AMedicare PIN