Healthcare Provider Details

I. General information

NPI: 1568043834
Provider Name (Legal Business Name): SIMARJEET PURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26750 PROVIDENCE PKWY STE 200
NOVI MI
48374-1212
US

IV. Provider business mailing address

16001 W 9 MILE RD FL 4
SOUTHFIELD MI
48075-4818
US

V. Phone/Fax

Practice location:
  • Phone: 866-974-2673
  • Fax:
Mailing address:
  • Phone: 248-849-2513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: