Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 01074508A | IN |
NPI | 1184903106 |
---|---|
Provider Name | Dr. Poonam M Puranik |
First Address | Indianapolis, IN 46206-1026 |
Second Address | Indianapolis, IN 46202-5109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2011 |
Last Update Date | 20/09/2019 |