Provider Demographics
NPI:1740639525
Name:PANKAJ NASHIKKAR MD LLC
Entity type:Organization
Organization Name:PANKAJ NASHIKKAR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:NASHIKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-232-1939
Mailing Address - Street 1:3745 OUTBACK VISTA PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-4605
Mailing Address - Country:US
Mailing Address - Phone:719-232-1939
Mailing Address - Fax:
Practice Address - Street 1:2920 N CASCADE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6262
Practice Address - Country:US
Practice Address - Phone:719-232-1939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14927837Medicaid
CO509715Medicare PIN