Basic Information
| Provider Information | |||||||||
| NPI: | 1124447032 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PURCELL | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | GREGORY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 376 W 10TH AVE | ||||||||
| Address2: | 760 PRIOR HALL | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432101280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142938305 | ||||||||
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| Practice Location | |||||||||
| Address1: | 376 W 10TH AVE | ||||||||
| Address2: | 760 PRIOR HALL | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432101280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142938305 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2014 | ||||||||
| LastUpdateDate: | 05/02/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 35129042 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.