Individual
PURSHOTHAM R GINNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
24 JOLIET ST, DYER, IN 46311-1705
(219) 865-2141
(219) 852-2502
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01069830A
IN
207R00000X
Internal Medicine Physician
125.054775
IL
207R00000X
Internal Medicine Physician
CDR.0002240
CO
207R00000X
Internal Medicine Physician
Q7046
TX
208M00000X
Hospitalist Physician
Primary
01069830A
IN
208M00000X
Hospitalist Physician
CDR.0002240
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1255584397
NPI
TX
01
—
CDR.0002240
STATE LICENSE
CO
01
—
Q7046
STATE LICENSE
TX
Enumeration date
11/03/2008
Last updated
04/21/2025
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