Individual
DR. PUNNOOSE MACKIEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1240 RIDGE RD, WAUKESHA, WI 53186-1425
(262) 574-9342
Mailing address
1240 RIDGE RD, WAUKESHA, WI 53186-1425
(262) 574-9342
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27717
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27717
STATE LICENSE
WI
Enumeration date
08/13/2006
Last updated
07/08/2007
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