Individual
RAJEESH S PUNNAKKATTU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1828 E FLORENCE BLVD, STE 112, CASA GRANDE, AZ 85122-4783
(520) 374-8915
(520) 374-8916
Mailing address
1828 E FLORENCE BLVD, STE 112, CASA GRANDE, AZ 85122-4783
(520) 374-8915
(520) 374-8916
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
31787
AZ
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
31787
AZ
207RP1001X
Pulmonary Disease Physician
Primary
31787
AZ
207RS0012X
Sleep Medicine (Internal Medicine) Physician
31787
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120730
MEDICARE PTAN
AZ
05
—
875312
—
AZ
01
—
P00174006
RAILROAD MEDICARE
AZ
01
—
WCSKQ
SUN HEALTH GROUP #
AZ
Enumeration date
08/02/2005
Last updated
04/02/2010
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