Individual
DR. ANDREI VLADIMIR PANKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1877 W DOWNER PL, AURORA, IL 60506-7302
(630) 906-5120
Mailing address
1870 W GALENA BLVD, AURORA, IL 60506-4356
(630) 859-6800
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036127557
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036127557
—
IL
Enumeration date
08/26/2008
Last updated
07/30/2012
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