Provider Demographics
NPI:1285434902
Name:UNIVERSAL MEDICAL GROUP
Entity type:Organization
Organization Name:UNIVERSAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:SURENDER
Authorized Official - Middle Name:
Authorized Official - Last Name:PUNIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-825-1766
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-0789
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91 GREGORY LN STE 20
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4925
Practice Address - Country:US
Practice Address - Phone:925-825-1766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty