Provider Demographics
NPI:1457396822
Name:PANKOW, DAWN K (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:K
Last Name:PANKOW
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 1:275 11TH ST S
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4655
Mailing Address - Country:US
Mailing Address - Phone:701-642-2000
Mailing Address - Fax:701-671-4106
Practice Address - Street 1:275 11TH ST S
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4655
Practice Address - Country:US
Practice Address - Phone:701-642-2000
Practice Address - Fax:701-671-4106
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5242207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND0105975OtherMEDICA #
NDDA9051015613OtherPREFERRED ONE #
ND35625OtherSIOUX VALLEY #
ND0105974OtherMEDICA #
NDHP19584OtherHEALTHPARTNERS #
ND142042OtherUCARE #
ND676669OtherAMERICA'S PPO/ARAZ #
NDND100018OtherLHS #
ND13254PAOtherMNBS #
ND15069Medicaid
ND2208OtherNDBS #
ND855577000Medicaid
ND33Q41PAOtherMNBS #
ND13254PAOtherMNBS #
D26197Medicare UPIN
ND0105974OtherMEDICA #