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Organization
HEAD SPORT EM LLC
Active
Organization
HEAD SPORT EM LLC
Active
Other names
Head Spine Sport
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG PANOS MD (OWNER)
(208) 512-4334
Entity
Organization
Contact information
Practice address
980 W IRONWOOD DR STE 206, COEUR D ALENE, ID 83814-2668
(208) 512-4334
Mailing address
980 W IRONWOOD DR STE 206, COEUR D ALENE, ID 83814-2668
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
11/01/2023
Last updated
11/01/2023
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