Provider Demographics
NPI:1619968013
Name:PUNNETT, MICHAEL AMES (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:AMES
Last Name:PUNNETT
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:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-489-5730
Mailing Address - Fax:502-489-5753
Practice Address - Street 1:6580 KENWOOD CROSSING RD
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-7614
Practice Address - Country:US
Practice Address - Phone:502-243-3161
Practice Address - Fax:502-243-3164
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062436A207Q00000X
KY37781208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64069289Medicaid
11199652OtherCAOH
IN200857410AMedicaid
KY64069289Medicaid
IN121630NMedicare UPIN
IN121630NMedicare UPIN