Provider Demographics
NPI:1871696195
Name:JOSHI, PANKAJKUMAR K (MD)
Entity type:Individual
Prefix:
First Name:PANKAJKUMAR
Middle Name:K
Last Name:JOSHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2595 TAMPA ROAD
Mailing Address - Street 2:SUITE D
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684
Mailing Address - Country:US
Mailing Address - Phone:727-773-8884
Mailing Address - Fax:727-784-5449
Practice Address - Street 1:2595 TAMPA ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684
Practice Address - Country:US
Practice Address - Phone:727-773-8884
Practice Address - Fax:727-784-5449
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258707600Medicaid
FL49210ZMedicare ID - Type Unspecified
H08456Medicare UPIN