Basic Information
| Provider Information | |||||||||
| NPI: | 1154405272 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATHEW | ||||||||
| FirstName: | PUTHENPURACKAL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 23RD AVE N | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153427339 | ||||||||
| FaxNumber: | 6153427340 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 23RD AVE N | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153427339 | ||||||||
| FaxNumber: | 6153427340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 06/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | MD29509 | TN | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
No ID Information.