Provider Demographics
NPI:1447295399
Name:PANNU, PRABHJOT S (MD)
Entity type:Individual
Prefix:
First Name:PRABHJOT
Middle Name:S
Last Name:PANNU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6628 HOLLINGSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-5007
Mailing Address - Country:US
Mailing Address - Phone:317-347-9912
Mailing Address - Fax:
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-554-0181
Practice Address - Fax:317-554-0105
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01054614A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine