1447453824 NPI number — ARKADIY V. PURYGIN, M.D., D.O., P.A.

Table of content: (NPI 1447453824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447453824 NPI number — ARKADIY V. PURYGIN, M.D., D.O., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARKADIY V. PURYGIN, M.D., D.O., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447453824
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4308 ALTON RD STE 880
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33140-4560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-535-0055
Provider Business Mailing Address Fax Number:
844-364-0130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4308 ALTON RD STE 880
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33140-4560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-535-0055
Provider Business Practice Location Address Fax Number:
844-364-0130
Provider Enumeration Date:
06/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PURYGIN
Authorized Official First Name:
ARKADIY
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
305-535-0055

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  OS 9336 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2728231 00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29414 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 29414A . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 006804900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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