Provider Demographics
NPI:1760046049
Name:LAKHMANI, PUNEET
Entity Type:Individual
Prefix:
First Name:PUNEET
Middle Name:
Last Name:LAKHMANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-9107
Mailing Address - Country:US
Mailing Address - Phone:601-613-3582
Mailing Address - Fax:
Practice Address - Street 1:320 W OHIO ST STE 410E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-6566
Practice Address - Country:US
Practice Address - Phone:888-928-5278
Practice Address - Fax:815-720-4950
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036159891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program