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1619968013

NPI Code Detail

MEDICARE: DR. MICHAEL AMES PUNNETT MD

MEDICARE: DR. MICHAEL AMES PUNNETT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01062436A	IN
2	208M00000X	Hospitalist Physician	37781	KY
3	207Q00000X	Family Medicine Physician	37781	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	11199652	OTHER		CAOH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619968013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL AMES PUNNETT MD

Provider Business Mailing Address
First Line	:	PO BOX 950248
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40295-0248
Country	:	US
Telephone Number	:	502-489-5730
Fax Number	:	502-489-5753

Provider Business Practice Location Address
First Line	:	6580 KENWOOD CROSSING RD
Second Line	:
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-7614
Country	:	US
Telephone Number	:	502-243-3161
Fax Number	:	502-243-3164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	12/08/2020

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Directions to “ DR. MICHAEL AMES PUNNETT MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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