Provider Demographics
NPI:1043273618
Name:PUNO, ROLANDO M (MD)
Entity Type:Individual
Prefix:
First Name:ROLANDO
Middle Name:M
Last Name:PUNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:SUITE 900
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3900
Practice Address - Country:US
Practice Address - Phone:502-584-7525
Practice Address - Fax:502-589-0849
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25585207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY163722400OtherUS DEPT OF LABOR
KY200011430OtherRAILROAD MEDICARE (SPINE
IN100373910AMedicaid
KY200031866OtherRAILROAD MEDICARE (UNIVER
KY1054522OtherPASSPORT (SPINE INSTITUTE
KY2433676000OtherPASSPORT ADVANTAGE (SPINE
00533157OtherMEDICARE/NLS
KY64255854Medicaid
N284257OtherHARMONY
KY000000049346OtherANTHEM (UNIVERSITY ORTHOP
KY1049640OtherPASSPORT (UNIVERSITY ORTH
KY000000049464OtherANTHEM (SPINE INSTITUTE)
KY2432616000OtherPASSPORT ADVANTAGE (UNIVE
N284257OtherHARMONY
KY000000049464OtherANTHEM (SPINE INSTITUTE)
KY1049640OtherPASSPORT (UNIVERSITY ORTH
KY64255854Medicaid