Basic Information
Provider Information
NPI: 1730110834
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PURI
FirstName: LALIT
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9650 GROSS POINT RD
Address2: SUITE 2900
City: SKOKIE
State: IL
PostalCode: 600761214
CountryCode: US
TelephoneNumber: 8478667846
FaxNumber:  
Practice Location
Address1: 9650 GROSS POINT RD
Address2: SUITE 2900
City: SKOKIE
State: IL
PostalCode: 600761214
CountryCode: US
TelephoneNumber: 8478667846
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/06/2006
LastUpdateDate: 03/03/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/03/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X036107033ILY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


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