Provider Demographics
NPI:1326048455
Name:PUMPUTIS, ,BIRUTE L (MD)
Entity Type:Individual
Prefix:
First Name:,BIRUTE
Middle Name:L
Last Name:PUMPUTIS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3926 NEW VISION DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1712
Mailing Address - Country:US
Mailing Address - Phone:260-266-1401
Mailing Address - Fax:260-458-5734
Practice Address - Street 1:3909 NEW VISION DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1725
Practice Address - Country:US
Practice Address - Phone:260-469-6610
Practice Address - Fax:260-969-3065
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2017-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01032732A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200153780Medicaid
D21870Medicare UPIN
IN170620Medicare ID - Type Unspecified