Provider Demographics
NPI:1588722060
Name:GUNEET PUREWAL PLLC
Entity type:Organization
Organization Name:GUNEET PUREWAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUNEET
Authorized Official - Middle Name:
Authorized Official - Last Name:PUREWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-723-4041
Mailing Address - Street 1:485 COLLIERS WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5012
Mailing Address - Country:US
Mailing Address - Phone:304-723-4041
Mailing Address - Fax:304-723-9604
Practice Address - Street 1:485 COLLIERS WAY
Practice Address - Street 2:SUITE B
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5012
Practice Address - Country:US
Practice Address - Phone:304-723-4041
Practice Address - Fax:304-723-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1804006000Medicaid
WV1804006000Medicaid
OH9366371Medicare ID - Type Unspecified
G82932Medicare UPIN