Provider Demographics
NPI:1205168887
Name:IYENGAR, PUNEETH (MD, PHD)
Entity type:Individual
Prefix:
First Name:PUNEETH
Middle Name:
Last Name:IYENGAR
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 FOREST PARK ROAD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9183
Mailing Address - Country:US
Mailing Address - Phone:646-408-3485
Mailing Address - Fax:
Practice Address - Street 1:5801 FOREST PARK ROAD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9183
Practice Address - Country:US
Practice Address - Phone:646-408-3485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN63832085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology