Provider Demographics
NPI:1457362394
Name:PANSE, MILIND P (MD)
Entity Type:Individual
Prefix:DR
First Name:MILIND
Middle Name:P
Last Name:PANSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 E LATHAM AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4423
Mailing Address - Country:US
Mailing Address - Phone:951-652-8700
Mailing Address - Fax:951-766-9944
Practice Address - Street 1:1225 E LATHAM AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4423
Practice Address - Country:US
Practice Address - Phone:951-652-8700
Practice Address - Fax:951-766-9944
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51330174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA8292OtherMEDICARE RAILROAD
CAZZZ25672ZMedicare PIN
CADA8292OtherMEDICARE RAILROAD