Provider Demographics
NPI:1669145959
Name:PUROHIT, EKTA
Entity type:Individual
Prefix:
First Name:EKTA
Middle Name:
Last Name:PUROHIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 BEDFORD SQUARE DR APT 103
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-4452
Mailing Address - Country:US
Mailing Address - Phone:248-928-6283
Mailing Address - Fax:
Practice Address - Street 1:1724 BEDFORD SQUARE DR APT 103
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48306-4452
Practice Address - Country:US
Practice Address - Phone:248-928-6283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704334174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily