Healthcare Provider Details

I. General information

NPI: 1457367211
Provider Name (Legal Business Name): KRISHAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1456 HUDSON RD
HILLSDALE MI
49242-8314
US

IV. Provider business mailing address

1456 HUDSON RD PO BOX 743
HILLSDALE MI
49242-8314
US

V. Phone/Fax

Practice location:
  • Phone: 517-439-0200
  • Fax:
Mailing address:
  • Phone: 517-439-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301080859
License Number StateMI

VIII. Authorized Official

Name: VIRENDER KRISHAN PURI
Title or Position: OWNER
Credential: M.D.
Phone: 517-439-0200