Provider Demographics
NPI:1730144007
Name:HALDER, PUNITA R (MD)
Entity Type:Individual
Prefix:
First Name:PUNITA
Middle Name:R
Last Name:HALDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3991 DUTCHMANS LN
Practice Address - Street 2:STE 205
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4723
Practice Address - Country:US
Practice Address - Phone:502-899-6170
Practice Address - Fax:502-899-6179
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY29679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6429691Medicaid
KY020504OtherSIHO - NMA
KY2686561000OtherPASSPORT ADVANTAGE - NMA
KY50008831OtherPASSPORT - NMA
KY000000350556OtherANTHEM - NMA
3074627003OtherCIGNA / NMA
KYP00176843OtherRAILROAD MEDICARE
1203693OtherCHA / NMA
000052155AOtherHUMANA / NMA
KY020504OtherSIHO - NMA
KY6429691Medicaid