Provider Demographics
NPI:1407092562
Name:PURI, VISHESH (MD)
Entity Type:Individual
Prefix:DR
First Name:VISHESH
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:PO BOX 638406
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8406
Mailing Address - Country:US
Mailing Address - Phone:513-984-3500
Mailing Address - Fax:513-791-2151
Practice Address - Street 1:4750 E GALBRAITH RD
Practice Address - Street 2:STE 103
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-6705
Practice Address - Country:US
Practice Address - Phone:513-984-3500
Practice Address - Fax:513-791-2151
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT207799207RN0300X
OH35.130233207RN0300X
IN01078053A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ2054003Medicare PIN
OHH511890Medicare PIN