Individual ProviderSumanth PunukolluFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address5960 Siegen Ln, Apt 9110, Baton Rouge, LA 70809(402) 218-9919PECOS EnrollmentBased on the most recent information from CMS, provider Sumanth Punukollu is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 11:51 AM.Profile DetailsProvider ID1891919395Provider TypeIndividualFull NamePunukollu, SumanthTitleDr.CredentialMDGenderMaleSole ProprietorYesEnumeration Date4/13/2007Last Updated3/8/2011Contact InformationPractice LocationPractice Address5960 Siegen Ln, Apt 9110, Baton Rouge, LA 70809Phone(402) 218-9919FaxUnlisted FaxMailing LocationMailing Address5960 Siegen Ln , Apt 9110, Baton Rouge, LA 70809Phone(402) 218-9919FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense203358LouisianaProvider IdentifiersIDDescriptionIssuerID1811068DescriptionMedicaidIssuerUnlistedLouisiana