Raymond J Punzalan, P.A.-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

085003684 Issued in IL

Practice address

901 McClintock Dr
Suite 202
Burr Ridge, IL 60527-0872

Phone

(888) 220-6432

Fax

(630) 654-4253

NPI assigned

Feb 15, 2010

Last updated

May 12, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431388800000",
    "number": "1760704902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MCCLINTOCK DR",
            "address_2": "SUITE 202",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605270872",
            "telephone_number": "888-220-6432",
            "fax_number": "630-654-4253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MCCLINTOCK DR",
            "address_2": "SUITE 202",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605270872",
            "telephone_number": "888-220-6432",
            "fax_number": "630-654-4253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUNZALAN",
        "first_name": "RAYMOND",
        "middle_name": "J",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-15",
        "last_updated": "2015-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085003684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085003684",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brad E Powell, DPT
• Sean W Powers, DO
• Prakash Vaishnav MD
• Prime Care Seven, LLC
• Chinnamma Punnackapadavil, MD
• Jay Purdy, MD
• Kenneth J Pursell, MD
• Kamaloshini Puthumana, MD
• Cathryn Quinlivan, DPT
• R&K Harmony Health Group PLLC

• Medical Physician Assistant in Burr Ridge, IL
• Providers in Burr Ridge, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.