Healthcare Provider Details

I. General information

NPI: 1255072971
Provider Name (Legal Business Name): PUNAM JITTIN MULJI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7833 S UNION AVE APT 1823
TULSA OK
74132-2760
US

IV. Provider business mailing address

7833 S UNION AVE APT 1823
TULSA OK
74132-2760
US

V. Phone/Fax

Practice location:
  • Phone: 864-327-6279
  • Fax:
Mailing address:
  • Phone: 864-327-6279
  • Fax: 918-561-1289

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 StateOK
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number8355
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: