Healthcare Provider Details

I. General information

NPI: 1225270440
Provider Name (Legal Business Name): VYTAUTAS PUKIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 WHITESBURG DR SE SUITE C
HUNTSVILLE AL
35801-4501
US

IV. Provider business mailing address

1508 BIG COVE RD SE
HUNTSVILLE AL
35801-2114
US

V. Phone/Fax

Practice location:
  • Phone: 256-883-0107
  • Fax: 256-883-0207
Mailing address:
  • Phone: 256-431-9257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29689
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: