Individual
DR. PREMRAJ MAKKUNI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
154 EXTON SQUARE MALL, EXTON, PA 19341-2440
(484) 476-1000
(484) 876-2164
Mailing address
3803 W CHESTER PIKE STE 160, NEWTOWN SQUARE, PA 19073-2336
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
57526-020
WI
207RC0000X
Cardiovascular Disease Physician
Primary
MD433572
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61338
DEAN HEALTH INSURANCE
WI
Enumeration date
05/15/2007
Last updated
04/16/2026
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