Provider Demographics
NPI:1033644737
Name:PANCHAL, NIKUL MAHENDRA
Entity type:Individual
Prefix:
First Name:NIKUL
Middle Name:MAHENDRA
Last Name:PANCHAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7730 W BOYNTON BEACH BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6155
Mailing Address - Country:US
Mailing Address - Phone:561-258-9430
Mailing Address - Fax:561-935-1582
Practice Address - Street 1:7730 W BOYNTON BEACH BLVD STE 7
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-6155
Practice Address - Country:US
Practice Address - Phone:561-258-9430
Practice Address - Fax:561-935-1582
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00362900213ES0103X
FLP04590213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery