Healthcare Provider Details

I. General information

NPI: 1710413539
Provider Name (Legal Business Name): PUNEET DHILLON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date: 12/14/2017
Reactivation Date: 12/28/2017

III. Provider practice location address

105 W 8TH AVE STE 7010
SPOKANE WA
99204-2312
US

IV. Provider business mailing address

PO BOX 421
LIBERTY LAKE WA
99019-0421
US

V. Phone/Fax

Practice location:
  • Phone: 509-353-3901
  • Fax: 509-353-3955
Mailing address:
  • Phone: 866-747-2455
  • Fax: 509-227-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT212491
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD61217578
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: