Provider Demographics
NPI:1356509947
Name:PANKONIN, MARK STEVEN (MD/PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:PANKONIN
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-2833
Mailing Address - Fax:989-583-1440
Practice Address - Street 1:900 COOPER AVE
Practice Address - Street 2:SUITE 4300
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5182
Practice Address - Country:US
Practice Address - Phone:989-583-7460
Practice Address - Fax:989-583-7432
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2021-02901207RG0100X
MI4301105873207RG0100X
MA295203207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology