Provider Demographics
NPI:1699773432
Name:PUNATAR, HARENDRA KESHAVLAL (MD)
Entity type:Individual
Prefix:
First Name:HARENDRA
Middle Name:KESHAVLAL
Last Name:PUNATAR
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 1:3536 MENDOCINO AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3634
Mailing Address - Country:US
Mailing Address - Phone:707-525-6485
Mailing Address - Fax:707-573-6165
Practice Address - Street 1:3536 MENDOCINO AVE
Practice Address - Street 2:STE 200
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3634
Practice Address - Country:US
Practice Address - Phone:707-573-6166
Practice Address - Fax:707-573-6165
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40868207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A408680OtherBLUE SHIELD OF CALIFORNIA
CA00A408680Medicaid
CA060017510OtherRAILROAD MEDICARE
CA00A408683Medicare PIN
CA00A408682Medicare PIN
CA00A408680OtherBLUE SHIELD OF CALIFORNIA