Provider Demographics
NPI:1194792531
Name:PANKEWYCZ, OLEH (MD)
Entity type:Individual
Prefix:
First Name:OLEH
Middle Name:
Last Name:PANKEWYCZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 RANCHO LN.
Mailing Address - Street 2:STE 250
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106
Mailing Address - Country:US
Mailing Address - Phone:702-383-2224
Mailing Address - Fax:702-383-3035
Practice Address - Street 1:901 RANCHO LN.
Practice Address - Street 2:STE 250
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-383-2224
Practice Address - Fax:702-383-3035
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221448207RN0300X
NV21454207RN0300X
PAMD061181L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02192309Medicaid
NYE67355Medicare UPIN
NY02192309Medicaid