Provider Demographics
NPI:1316985906
Name:PUNJABI, HARESH M (MD)
Entity type:Individual
Prefix:DR
First Name:HARESH
Middle Name:M
Last Name:PUNJABI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HARRY
Other - Middle Name:
Other - Last Name:PUNJABI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:267-448-4908
Mailing Address - Fax:
Practice Address - Street 1:2250 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-3831
Practice Address - Country:US
Practice Address - Phone:215-427-3343
Practice Address - Fax:215-427-0533
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038426L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00839466-02Medicaid
PA842271Medicare ID - Type Unspecified
PA00839466-02Medicaid