Individual
MICHAEL JUDE PANKAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3430 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7579
(208) 523-3060
(208) 523-0028
Mailing address
3430 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7579
(208) 523-3060
(208) 523-0028
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
F9918
TX
208000000X
Pediatrics Physician
Primary
M4815
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010005951
BLUE SHIELD
ID
05
—
0038900000
—
ID
05
—
0117402
—
MT
05
—
110702000
—
WY
05
—
1285786046
—
WY
01
—
48157
BLUE CROSS
ID
Enumeration date
08/19/2006
Last updated
09/10/2009
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