Healthcare Provider Details

I. General information

NPI: 1447448378
Provider Name (Legal Business Name): MICHAEL B PURNELL M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 COFFEE RD STE 100
MODESTO CA
95355-3192
US

IV. Provider business mailing address

1335 COFFEE RD STE 100
MODESTO CA
95355-3192
US

V. Phone/Fax

Practice location:
  • Phone: 209-524-5977
  • Fax: 209-524-7395
Mailing address:
  • Phone: 209-524-5977
  • Fax: 209-524-7395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA454810
License Number StateCA

VIII. Authorized Official

Name: COLLETTE J CASTILLO
Title or Position: BILLING SUPERVISOR
Credential: CPC
Phone: 209-524-4438