Provider Demographics
NPI:1013694736
Name:PANWAR, VASIM RAJA
Entity type:Individual
Prefix:
First Name:VASIM
Middle Name:RAJA
Last Name:PANWAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 SW 73RD WAY APT 1611
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1015
Mailing Address - Country:US
Mailing Address - Phone:773-923-5231
Mailing Address - Fax:
Practice Address - Street 1:3300 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33328-2004
Practice Address - Country:US
Practice Address - Phone:954-262-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-04
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program