Healthcare Provider Details

I. General information

NPI: 1770530917
Provider Name (Legal Business Name): MURALI PUTHISIGAMANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 VIRGINIA ST 4TH FLOOR
DUNEDIN FL
34698
US

IV. Provider business mailing address

PO BOX 2216
DUNEDIN FL
34697
US

V. Phone/Fax

Practice location:
  • Phone: 727-734-6932
  • Fax: 727-734-4516
Mailing address:
  • Phone: 727-734-6932
  • Fax: 727-734-4516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME91107
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: