Provider Demographics
NPI:1194560581
Name:PUREWAL, JASKIRAN (MD)
Entity type:Individual
Prefix:MISS
First Name:JASKIRAN
Middle Name:
Last Name:PUREWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3439 WOODWARD AVENUE,
Mailing Address - Street 2:UNIT 228
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-398-8278
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST., 9C-UHC DETROIT MEDICAL CENTER
Practice Address - Street 2:GRADUATE MEDICAL EDUCATION OFFICE
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5146
Practice Address - Fax:313-993-8501
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4351053306390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program