Healthcare Provider Details

I. General information

NPI: 1396737177
Provider Name (Legal Business Name): BHABENDRA N. PUTATUNDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 BABB DR STE. B
LEBANON TN
37087-2508
US

IV. Provider business mailing address

212 BABB DR STE. B
LEBANON TN
37087-2508
US

V. Phone/Fax

Practice location:
  • Phone: 615-449-1459
  • Fax: 615-453-2853
Mailing address:
  • Phone: 615-449-1459
  • Fax: 615-453-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number21370
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: