Provider Demographics
NPI:1114163664
Name:PUNO, AILEEN FELIZA (MD)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:FELIZA
Last Name:PUNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AILEEN FELIZA
Other - Middle Name:MACADA
Other - Last Name:DE LOS SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9351 CAMERON RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-7797
Mailing Address - Country:US
Mailing Address - Phone:317-997-3125
Mailing Address - Fax:
Practice Address - Street 1:9351 CAMERON RIDGE LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-7797
Practice Address - Country:US
Practice Address - Phone:317-997-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066130A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200933960Medicaid