Provider Demographics
NPI:1346262698
Name:PUROHIT, AMISH R (MD)
Entity Type:Individual
Prefix:
First Name:AMISH
Middle Name:R
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 1:520 RIVERGATE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2030
Mailing Address - Country:US
Mailing Address - Phone:615-859-3937
Mailing Address - Fax:615-859-3919
Practice Address - Street 1:520 RIVERGATE PARKWAY
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2030
Practice Address - Country:US
Practice Address - Phone:615-859-3937
Practice Address - Fax:615-859-3919
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118478207W00000X
TNMD51925207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036118478Medicaid
ILP00404400OtherRR MEDICARE
ILK40072Medicare PIN
IL036118478Medicaid