Basic Information
| Provider Information | |||||||||
| NPI: | 1962655159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PURUGGANAN | ||||||||
| FirstName: | MISAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PURUGGANAN | ||||||||
| OtherFirstName: | MISAEL | ||||||||
| OtherMiddleName: | VERA CRUZ | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3555 OLENTANGY RIVER RD | ||||||||
| Address2: | SUITE 1080 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432143912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142688164 | ||||||||
| FaxNumber: | 6142688406 | ||||||||
| Practice Location | |||||||||
| Address1: | 3555 OLENTANGY RIVER RD | ||||||||
| Address2: | SUITE 1080 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432143912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142688164 | ||||||||
| FaxNumber: | 6142688406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2008 | ||||||||
| LastUpdateDate: | 12/19/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 35097344 | OH | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 35097344 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0053603 | 05 | OH | MEDICAID |