Individual
PANKAJ PRASUN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1500 HIGHLAND AVE, MADISON, WI 53705-2274
(608) 262-2507
Mailing address
1 GUSTAVE L LEVY PL # 1497, NEW YORK, NY 10029-6504
(212) 241-6947
(212) 860-3316
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
3675
WI
208000000X
Pediatrics Physician
4301091882
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5362363
UNITED HEALTHCARE
NY
Enumeration date
08/25/2008
Last updated
01/11/2024
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