Provider Demographics
NPI:1770530917
Name:PUTHISIGAMANI, MURALI (MD)
Entity type:Individual
Prefix:DR
First Name:MURALI
Middle Name:
Last Name:PUTHISIGAMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2216
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34697
Mailing Address - Country:US
Mailing Address - Phone:727-734-6932
Mailing Address - Fax:727-734-4516
Practice Address - Street 1:646 VIRGINIA ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698
Practice Address - Country:US
Practice Address - Phone:727-734-6932
Practice Address - Fax:727-734-4516
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91107207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272854100Medicaid
FLU5201ZMedicare ID - Type Unspecified
FL272854100Medicaid