Basic Information
| Provider Information | |||||||||
| NPI: | 1740941806 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANKUCH | ||||||||
| FirstName: | BRANDON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8104 IVANDALE DR | ||||||||
| Address2: | |||||||||
| City: | PARMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441294312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407811743 | ||||||||
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| Practice Location | |||||||||
| Address1: | 525 E MARKET ST | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303753000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2021 | ||||||||
| LastUpdateDate: | 12/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 403937 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.