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Individual
LYLE D PAHNKE JR.
Active
Individual
LYLE D PAHNKE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036089773
IL
208600000X
Surgery Physician
036089773
IL
2086S0129X
Vascular Surgery Physician
Primary
036089773
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036089773
—
IL
01
—
207988
GROUP
IL
01
—
CG2264
RR GROUP NUMBER
IL
01
—
P00169541
RR MEDICARE NUMBER
IL
Enumeration date
05/23/2006
Last updated
04/15/2022
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