Healthcare Provider Details

I. General information

NPI: 1649652280
Provider Name (Legal Business Name): ANGELA SUHALE PUTHENVEETIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 W INA RD STE 215&221
TUCSON AZ
85741-2350
US

IV. Provider business mailing address

PO BOX 188
MARANA AZ
85653-0188
US

V. Phone/Fax

Practice location:
  • Phone: 520-616-1531
  • Fax: 520-616-1536
Mailing address:
  • Phone: 520-682-4111
  • Fax: 520-616-1442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11018086A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number56136
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: