Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | 036107895 | IL |
NPI | 1023097839 |
---|---|
Provider Name | Dr. Sanjeev Puri |
First Address | Davenport, IA 52803-2473 |
Second Address | Moline, IL 61265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 10/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3561308 | (05) | IA |
G87443 | (02) | |
P00208166 | MEDICARE RAILROAD (01) |