Provider Demographics
NPI:1881702793
Name:PURI, AMITAB K G (MD)
Entity type:Individual
Prefix:DR
First Name:AMITAB
Middle Name:K G
Last Name:PURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5310 N LA CHOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3815
Mailing Address - Country:US
Mailing Address - Phone:520-490-7171
Mailing Address - Fax:520-229-9107
Practice Address - Street 1:5310 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3815
Practice Address - Country:US
Practice Address - Phone:520-229-8878
Practice Address - Fax:520-229-9107
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ25648207RS0012X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
290013518OtherRAILROAD MEDICARE
AZ401315Medicaid
AZ0875970OtherBCBS OF AZ
G58304Medicare UPIN
AZZ63408Medicare PIN