Provider Demographics
NPI:1609667567
Name:PUNT, TRISTA JACOBIA (DO, MS)
Entity type:Individual
Prefix:
First Name:TRISTA
Middle Name:JACOBIA
Last Name:PUNT
Suffix:
Gender:F
Credentials:DO, MS
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44405 WOODWARD AVE
Mailing Address - Street 2:GRADUATE MEDICAL EDUCATION DEPT.
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44405 WOODWARD AVE
Practice Address - Street 2:GRADUATE MEDICAL EDUCATION DEPT.
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5023
Practice Address - Country:US
Practice Address - Phone:248-931-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5151017624207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5151017624OtherOSTEOPATHIC PHYSICIAN EDUCATIONAL LIMITED LICENSE