LYLE D PAHNKE MD NPI 1770538225

NPI Information

NPI: 1770538225
Provider Name: LYLE D PAHNKE, MD
Classification: Surgery - 2086S0129X
Entity Type: Individual

Specialization: Vascular Surgery

PECOS Registration: Yes

Address:
400 N PLEASANT AVE
CENTRALIA, IL
ZIP 62801
Phone: (618) 436-6318
Get Directions

Lyle D Pahnke, MD is a vascular surgery surgery in Centralia, IL with 54 years of experience. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. Lyle D Pahnke, MD NPI is 1770538225. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

400 N PLEASANT AVE
CENTRALIA, IL
ZIP 62801-056
Phone: (618) 436-6318
Fax: (618) 436-6386

The NPI 1770538225 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/23/2006 and was last updated on 4/15/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		036089773	ILLINOIS	No
2	208600000X	Surgery		036089773	ILLINOIS	No
3	2086S0129X	Surgery	Vascular Surgery	036089773	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	207988	OTHER	ILLINOIS	GROUP
2	CG2264	OTHER	ILLINOIS	RR GROUP NUMBER
3	P00169541	OTHER	ILLINOIS	RR MEDICARE NUMBER
4	036089773	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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