Basic Information
| Provider Information | |||||||||
| NPI: | 1346360229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PURAKAL | ||||||||
| FirstName: | JOYCE | ||||||||
| MiddleName: | CATHERINE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21000 E 12 MILE RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | SAINT CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480811156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864475100 | ||||||||
| FaxNumber: | 5864475090 | ||||||||
| Practice Location | |||||||||
| Address1: | 21000 E 12 MILE RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | SAINT CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480811156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864475100 | ||||||||
| FaxNumber: | 5864475090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 02/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301081983 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | JP081983 | 01 | MI | BCBS | OTHER |