Individual
DIVYESH PUROHIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
557 W BROADWAY, SHELBURN, IN 47879
(812) 234-6053
(812) 478-3416
Mailing address
3991 GOLF BAG LN, TERRE HAUTE, IN 47802-8145
(812) 299-3261
(812) 316-5151
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01045492A
IN
208D00000X
General Practice Physician
01045492A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000205869
BLUE COSS PROVIDER #
—
05
—
200111590
—
IN
Enumeration date
01/18/2006
Last updated
05/12/2022
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