Provider Demographics
NPI:1528128311
Name:SATINDER S. PUREWAL, M.D. LLC
Entity type:Organization
Organization Name:SATINDER S. PUREWAL, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:PUREWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-878-2100
Mailing Address - Street 1:6677 W THUNDERBIRD RD
Mailing Address - Street 2:BLDING I-164
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3709
Mailing Address - Country:US
Mailing Address - Phone:623-878-2100
Mailing Address - Fax:623-776-9419
Practice Address - Street 1:6677 W THUNDERBIRD RD
Practice Address - Street 2:BLDING I-164
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3709
Practice Address - Country:US
Practice Address - Phone:623-878-2100
Practice Address - Fax:623-776-9419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ268542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ100491Medicare ID - Type Unspecified