Healthcare Provider Details

I. General information

NPI: 1760046049
Provider Name (Legal Business Name): PUNEET LAKHMANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W OHIO ST STE 410E
CHICAGO IL
60654-6566
US

IV. Provider business mailing address

208 VALLEY RD
RIDGELAND MS
39157-9107
US

V. Phone/Fax

Practice location:
  • Phone: 888-928-5278
  • Fax: 815-720-4950
Mailing address:
  • Phone: 601-613-3582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036159891
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: