Provider Demographics
NPI:1033679972
Name:PUNTKATTALEE, MELISSA JANE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:PUNTKATTALEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35212-2522
Mailing Address - Country:US
Mailing Address - Phone:205-380-9455
Mailing Address - Fax:
Practice Address - Street 1:5720 1ST AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35212-2522
Practice Address - Country:US
Practice Address - Phone:205-380-9455
Practice Address - Fax:205-380-9459
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.48133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine