Provider Demographics
NPI:1407845720
Name:PUNWANI, MANISHA RAM (MD)
Entity Type:Individual
Prefix:
First Name:MANISHA
Middle Name:RAM
Last Name:PUNWANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 BUSH ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5239
Mailing Address - Country:US
Mailing Address - Phone:217-691-0186
Mailing Address - Fax:415-704-3206
Practice Address - Street 1:1801 BUSH ST
Practice Address - Street 2:SUITE 118
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5239
Practice Address - Country:US
Practice Address - Phone:217-691-0186
Practice Address - Fax:415-704-3206
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2014-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552962084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036119462Medicaid
IL256510Medicare PIN
IL036119462Medicaid