Provider Demographics
NPI:1326028309
Name:PUROHIT, DIVYESH (MD)
Entity Type:Individual
Prefix:
First Name:DIVYESH
Middle Name:
Last Name:PUROHIT
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 1:3991 GOLF BAG LN
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-8145
Mailing Address - Country:US
Mailing Address - Phone:812-299-3261
Mailing Address - Fax:812-316-5151
Practice Address - Street 1:557 W BROADWAY
Practice Address - Street 2:
Practice Address - City:SHELBURN
Practice Address - State:IN
Practice Address - Zip Code:47879
Practice Address - Country:US
Practice Address - Phone:812-234-6053
Practice Address - Fax:812-478-3416
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045492A208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000205869OtherBLUE COSS PROVIDER #
IN200111590Medicaid
000000205869OtherBLUE COSS PROVIDER #
IN200111590Medicaid