Provider Demographics
NPI:1508099094
Name:PURYSKO, ANDREI SARAIVA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREI
Middle Name:SARAIVA
Last Name:PURYSKO
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 1:9500 EUCLID AVE
Mailing Address - Street 2:MAIL CODE JB3
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-1710
Mailing Address - Country:US
Mailing Address - Phone:216-445-9005
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:MAIL CODE JB3
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-1710
Practice Address - Country:US
Practice Address - Phone:216-445-9005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.1209112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program