Healthcare Provider Details

I. General information

NPI: 1619801628
Provider Name (Legal Business Name): NIKHIL GANESH PURI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24911 LITTLE MACK SUITE C
ST. CLAIR SHORES MI
48080
US

IV. Provider business mailing address

24911 LITTLE MACK SUITE C
ST. CLAIR SHORES MI
48080
US

V. Phone/Fax

Practice location:
  • Phone: 586-777-2050
  • Fax: 586-777-2189
Mailing address:
  • Phone: 586-777-2050
  • Fax: 586-777-2189

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: