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General NPI Number Information
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NPI Number | 1447448378
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Entity Type | Organization
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Legal Business Name | MICHAEL B PURNELL M D INC
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 1335 COFFEE RD STE 100
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City | MODESTO
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State | CA
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Zip | 95355-3192
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Country | US
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Telephone | 209-524-5977
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Fax | 209-524-7395
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Provider Business Mailing Address
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Address Line | 1335 COFFEE RD STE 100
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City | MODESTO
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State | CA
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Zip | 95355-3192
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Country | US
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Telephone | 209-524-5977
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Fax | 209-524-7395
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | COLLETTE J CASTILLO
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Credential | CPC
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Telephone | 209-524-4438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A454810
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License Number State | CA
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