Provider Demographics
NPI:1861699761
Name:PANCZYK, ELIZA (MD)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:PANCZYK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 W DUVAL MINE RD STE 111
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-5004
Mailing Address - Country:US
Mailing Address - Phone:520-797-8550
Mailing Address - Fax:520-797-8537
Practice Address - Street 1:1295 W DUVAL MINE RD STE 111
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-5004
Practice Address - Country:US
Practice Address - Phone:520-797-8550
Practice Address - Fax:520-797-8537
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT44424207RC0000X
AZ43432207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease