Individual
MR. MARK WALTER PANKONIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 MIDLAND RD, SAGINAW, MI 48638
(989) 793-0510
(989) 793-9491
Mailing address
1600 MIDLAND RD, SAGINAW, MI 48638
(989) 793-0510
(989) 793-9491
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MP035123
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0722726
HEALTHPLUS
MI
01
—
0732272
BLUE CROSS BLUE SHEILD OF
MI
01
—
080181742
RAILROAD MEDICARE
MI
Enumeration date
09/28/2006
Last updated
12/18/2009
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