Provider Demographics
NPI:1013928183
Name:PANKNIN, DANA DEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:DEE
Last Name:PANKNIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 US HIGHWAY 23 N
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-8018
Mailing Address - Country:US
Mailing Address - Phone:989-356-4049
Mailing Address - Fax:989-356-3712
Practice Address - Street 1:1185 US HIGHWAY 23 N
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-8018
Practice Address - Country:US
Practice Address - Phone:989-356-4049
Practice Address - Fax:989-356-3712
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDP038510208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4360783Medicaid
MI4360783Medicaid
MIZ16001015Medicare PIN