Individual
PURUSHOTTAM K. DIXIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3601 W 13 MILE RD, BEAUMONT HOSPITAL - RO, ROYAL OAK, MI 48073-6712
(248) 585-8271
Mailing address
130 TOWN CENTER DR STE 203, BEAUMONT MEDICAL STAFF AFFAIRS, TROY, MI 48084-1744
(248) 585-8216
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
4301072046
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
489597310
—
MI
01
—
700H262300
BLUE CROSS-BLUE CROSS
—
01
—
PD072046
COMMERCIAL-COMMERCIAL NUMBER
—
Enumeration date
07/28/2006
Last updated
10/21/2020
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