Provider Demographics
NPI:1689660474
Name:PURI, RAJNISH (DO)
Entity Type:Individual
Prefix:
First Name:RAJNISH
Middle Name:
Last Name:PURI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 N SEMORAN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3803
Mailing Address - Country:US
Mailing Address - Phone:407-678-5656
Mailing Address - Fax:407-677-5550
Practice Address - Street 1:471 N SEMORAN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3803
Practice Address - Country:US
Practice Address - Phone:407-678-5656
Practice Address - Fax:407-677-5550
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S8896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37976OtherBLUE CROSS BLUE SHIELD
FLG37856Medicare UPIN
FL37976OtherBLUE CROSS BLUE SHIELD
FLK4341Medicare ID - Type UnspecifiedGROUP IDENTIFIER