Healthcare Provider Details

I. General information

NPI: 1558596429
Provider Name (Legal Business Name): PUNEET SINGLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 MEDICAL PARK DR SE
GRAND RAPIDS MI
49546-3607
US

IV. Provider business mailing address

PO BOX 1608
GRAND RAPIDS MI
49501-1608
US

V. Phone/Fax

Practice location:
  • Phone: 800-949-8439
  • Fax: 616-285-9144
Mailing address:
  • Phone: 800-968-6866
  • Fax: 616-532-7230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301100807
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: