Healthcare Provider Details

I. General information

NPI: 1982605887
Provider Name (Legal Business Name): RAJEESH S PUNNAKKATTU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 E FLORENCE BLVD STE 110
CASA GRANDE AZ
85122-4782
US

IV. Provider business mailing address

1780 E FLORENCE BLVD STE 110
CASA GRANDE AZ
85122-4782
US

V. Phone/Fax

Practice location:
  • Phone: 520-374-8915
  • Fax: 520-233-7015
Mailing address:
  • Phone: 520-374-8915
  • Fax: 520-233-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number31787
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31787
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number31787
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number31787
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: