Provider Demographics
NPI:1184237877
Name:SUDEEP PUNIA MD PC
Entity type:Organization
Organization Name:SUDEEP PUNIA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEEVAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PUNIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-900-2454
Mailing Address - Street 1:C/O ABLOOMMEDICAL SPA
Mailing Address - Street 2:17218 N 72ND DR,#110
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308
Mailing Address - Country:US
Mailing Address - Phone:623-691-8319
Mailing Address - Fax:623-398-7678
Practice Address - Street 1:7330 N 99TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85307-3018
Practice Address - Country:US
Practice Address - Phone:623-691-8319
Practice Address - Fax:623-398-7678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty