Provider Demographics
NPI:1851556591
Name:PURI, VIMAL P (MD)
Entity Type:Individual
Prefix:
First Name:VIMAL
Middle Name:P
Last Name:PURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WOODBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-4364
Mailing Address - Country:US
Mailing Address - Phone:313-568-1433
Mailing Address - Fax:313-568-0155
Practice Address - Street 1:600 WOODBRIDGE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-4364
Practice Address - Country:US
Practice Address - Phone:313-568-1433
Practice Address - Fax:313-568-0155
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301032313208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice