Individual
MR. SURENDAR S PUROHIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
850 W NORTH ST STE 100, JACKSON, MI 49202-3196
(517) 841-3033
(517) 841-3034
Mailing address
850 W NORTH ST STE 104, JACKSON, MI 49202-3196
(877) 852-8463
(517) 817-0144
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
4301064466
MI
207W00000X
Ophthalmology Physician
G86170
CA
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
4301064466
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G861701
BLUE CROSS
CA
05
—
00G861701
—
CA
01
—
180C846310
BCBSM
MI
01
—
180H149970
BCBSM
MI
05
—
4704712
—
MI
05
—
4704721
—
MI
05
—
4704740
—
MI
05
—
4704786
—
MI
01
—
P00203853
RAILROAD MEDICARE
—
Enumeration date
10/11/2005
Last updated
09/19/2018
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