MEDICARE: MR. SURENDAR S PUROHIT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	4301064466	MI
2	207W00000X	Ophthalmology Physician	G86170	CA
3	207WX0107X	Retina Specialist (Ophthalmology) Physician	4301064466	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00203853	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G861701	OTHER	CA	BLUE CROSS
2	180H149970	OTHER	MI	BCBSM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	180C846310	OTHER	MI	BCBSM
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205824547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SURENDAR S PUROHIT M.D.

Provider Business Mailing Address
First Line	:	850 W NORTH ST STE 104
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-3196
Country	:	US
Telephone Number	:	877-852-8463
Fax Number	:	517-817-0144

Provider Business Practice Location Address
First Line	:	850 W NORTH ST STE 100
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-3196
Country	:	US
Telephone Number	:	517-841-3033
Fax Number	:	517-841-3034

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	09/19/2018

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Directions to “ MR. SURENDAR S PUROHIT M.D.” Practice Location

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