Provider Demographics
NPI:1255366068
Name:PURPURA, JOSEPH MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MATTHEW
Last Name:PURPURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:660 N WESTMORELAND RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1659
Mailing Address - Country:US
Mailing Address - Phone:847-234-4595
Mailing Address - Fax:847-234-4597
Practice Address - Street 1:660 N WESTMORELAND RD
Practice Address - Street 2:SUITE 303
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1659
Practice Address - Country:US
Practice Address - Phone:847-234-4595
Practice Address - Fax:847-234-4597
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00977OtherPIN
ILP00977OtherPIN