Healthcare Provider Details

I. General information

NPI: 1194661421
Provider Name (Legal Business Name): ANURAG REDDY PUNNAM M.D.
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 W. OUTER DRIVE, SINAI-GRACE HOSPITAL/DETROIT MEDIC DEPARTMENT OF INTERNAL MEDICINE, NORTHWEST REGION
DETROIT MI
48235
US

IV. Provider business mailing address

6071 W. OUTER DRIVE, SINAI-GRACE HOSPITAL/DETROIT MEDIC DEPARTMENT OF INTERNAL MEDICINE, NORTHWEST REGION
DETROIT MI
48235
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-7434
  • Fax: 313-966-1738
Mailing address:
  • Phone: 313-966-7434
  • Fax: 313-966-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: