Provider Demographics
NPI:1508892118
Name:PUNJA, MADHUKAR K (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHUKAR
Middle Name:K
Last Name:PUNJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 NW 64TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4218
Mailing Address - Country:US
Mailing Address - Phone:352-331-2485
Mailing Address - Fax:352-331-0047
Practice Address - Street 1:1173 NW 64TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4218
Practice Address - Country:US
Practice Address - Phone:352-331-2485
Practice Address - Fax:352-331-0047
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME #55179207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF80163Medicare UPIN
FL25115ZMedicare PIN