Individual
CONSTANTINE PAUL PANAKOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
606 N MULBERRY RD, TANGLEWOOD MEDICAL CENTER, PA, DERBY, KS 67037-3532
(316) 788-3787
(316) 788-2618
Mailing address
606 N MULBERRY RD, TANGLEWOOD MEDICAL CLINIC, PA, DERBY, KS 67037-3532
(316) 788-3787
(316) 788-2618
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0530413
KS
207Q00000X
Family Medicine Physician
3867
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114949179
—
IA
01
—
71590
BCBS
—
Enumeration date
07/25/2006
Last updated
04/06/2015
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