Provider Demographics
NPI:1013000926
Name:JYOTHI PURAM, M.D., INC
Entity Type:Organization
Organization Name:JYOTHI PURAM, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADHUKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NARAHARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-943-3839
Mailing Address - Street 1:1604 LANCASTER AVE # B
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2639
Mailing Address - Country:US
Mailing Address - Phone:614-943-3839
Mailing Address - Fax:866-421-8583
Practice Address - Street 1:1176 E HOME RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2726
Practice Address - Country:US
Practice Address - Phone:937-342-9861
Practice Address - Fax:380-203-1298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH64595207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0833911Medicare ID - Type Unspecified