Provider Demographics
NPI:1710319959
Name:PUTHENPURAKAL, KRITI (DPM)
Entity Type:Individual
Prefix:
First Name:KRITI
Middle Name:
Last Name:PUTHENPURAKAL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 GREENE RD
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517
Mailing Address - Country:US
Mailing Address - Phone:630-202-4898
Mailing Address - Fax:
Practice Address - Street 1:640 S WASHINGTON ST
Practice Address - Street 2:STE 380
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6787
Practice Address - Country:US
Practice Address - Phone:630-272-6441
Practice Address - Fax:630-527-6392
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL135000824213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery