Provider Demographics
NPI:1003060211
Name:PURI, VICHIN (MD)
Entity Type:Individual
Prefix:
First Name:VICHIN
Middle Name:
Last Name:PURI
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 1:3400 W WHEATLAND RD BLDG 3 # 360
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237
Mailing Address - Country:US
Mailing Address - Phone:214-884-4700
Mailing Address - Fax:214-884-4761
Practice Address - Street 1:1411 N. BECKLEY AVE.
Practice Address - Street 2:PAVILION III, SUITE 268
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-7520
Practice Address - Country:US
Practice Address - Phone:214-947-4400
Practice Address - Fax:214-947-4404
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1109204F00000X
TN50416208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6002233OtherBCBS
MS03977069Medicaid
TNP01473968OtherRAILROAD MEDICARE
TNQ002437Medicaid
AR201068001Medicaid
TNP01473968OtherRAILROAD MEDICARE