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General NPI Number Information
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NPI Number | 1558110593
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Entity Type | Individual
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Provider Name | VIJAY PUTHERICKAL DO
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Gender | Male
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Dates
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Enumeration Date | 05/14/2024
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 401 N EWING ST
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City | LANCASTER
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State | OH
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Zip | 43130-3372
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Country | US
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Telephone | 800-548-2627
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 GREENWOOD RD
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City | SHREVEPORT
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State | LA
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Zip | 71103-3908
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Country | US
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Telephone | 318-212-4000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 348135
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License Number State | LA
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