Provider Demographics
NPI:1922069939
Name:PUROHIT, SUJATA (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUJATA
Middle Name:
Last Name:PUROHIT
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 1:850 W NORTH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3196
Mailing Address - Country:US
Mailing Address - Phone:517-782-9436
Mailing Address - Fax:517-782-5166
Practice Address - Street 1:1116 W GANSON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-4240
Practice Address - Country:US
Practice Address - Phone:517-782-9436
Practice Address - Fax:517-782-5166
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086397207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI180H149970OtherBCBSM
MI4795870Medicaid
MI4795922Medicaid
H14997024Medicare ID - Type Unspecified
MI180H149970OtherBCBSM
MI0C84631032Medicare PIN