Provider Demographics
NPI:1932198512
Name:HUKKU, PANKAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:PANKAJ
Middle Name:
Last Name:HUKKU
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:PO BOX 2502
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-2502
Mailing Address - Country:US
Mailing Address - Phone:248-212-6442
Mailing Address - Fax:248-280-0222
Practice Address - Street 1:1380 COOLIDGE HWY STE 110
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7067
Practice Address - Country:US
Practice Address - Phone:248-280-1867
Practice Address - Fax:248-280-0222
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047842207RP1001X, 207RS0012X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2571199-10Medicaid
MI2571199-10Medicaid
0634698Medicare ID - Type Unspecified