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1215324116

NPI Code Detail

MEDICARE: SANDEEP KUMAR PURI MD

MEDICARE: SANDEEP KUMAR PURI MD

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	208000000X	Pediatrics Physician	91546	SC
2	208000000X	Pediatrics Physician	60486	MN
3	208000000X	Pediatrics Physician	275177	MA
4	2080P0206X	Pediatric Gastroenterology Physician	91546	SC

General Provider Information

NPI Number	:	1215324116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDEEP KUMAR PURI MD

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:	864-522-8603
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 RICHLAND MEDICAL PARK DR STE 310
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6883
Country	:	US
Telephone Number	:	803-434-8450
Fax Number	:	803-434-0137

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

Provider Enumeration Date	:	04/20/2015
Last Update Date	:	06/28/2024

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Directions to “ SANDEEP KUMAR PURI MD” Practice Location

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