Provider Demographics
NPI:1972949287
Name:PUSKOOR, AKHILDEEP VENKATA (MD)
Entity Type:Individual
Prefix:DR
First Name:AKHILDEEP
Middle Name:VENKATA
Last Name:PUSKOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VENKATA
Other - Middle Name:AKHILDEEP
Other - Last Name:PUSKOOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9500 STOCKDALE HWY STE 203
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3621
Practice Address - Country:US
Practice Address - Phone:661-587-8110
Practice Address - Fax:661-587-8220
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301110119207R00000X
CAA155027208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine