Provider Demographics
NPI:1063584092
Name:PUTNAM, MICHELLE ANN (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3831 HUGHES AVE
Mailing Address - Street 2:STE 704
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-6839
Mailing Address - Country:US
Mailing Address - Phone:310-204-4111
Mailing Address - Fax:310-204-4474
Practice Address - Street 1:3831 HUGHES AVE
Practice Address - Street 2:SUITE 504
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2751
Practice Address - Country:US
Practice Address - Phone:310-204-4111
Practice Address - Fax:310-204-4474
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2020-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA83674207YS0123X, 207YX0602X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA83674AMedicare PIN
CAI01800Medicare UPIN