Provider Demographics
NPI:1285897272
Name:MADAN, PANKAJ (MD)
Entity type:Individual
Prefix:DR
First Name:PANKAJ
Middle Name:
Last Name:MADAN
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 1:408 CLIFFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1513
Mailing Address - Country:US
Mailing Address - Phone:206-218-3652
Mailing Address - Fax:
Practice Address - Street 1:21727 IH 10 W STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-2108
Practice Address - Country:US
Practice Address - Phone:210-644-1230
Practice Address - Fax:210-702-4615
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6873207RC0000X
MN106351207R00000X
MN55705207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX359162001Medicaid
TX8FV105OtherBCBS
TX498304YR99OtherMEDICARE
TX8FV105OtherBCBS