Basic Information
| Provider Information | |||||||||
| NPI: | 1306072129 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POPINCHALK | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21097 NE 27TH CT | ||||||||
| Address2: | SUITE 540 | ||||||||
| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331801204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7866232000 | ||||||||
| FaxNumber: | 7862214276 | ||||||||
| Practice Location | |||||||||
| Address1: | 21097 NE 27TH CT | ||||||||
| Address2: | SUITE 540 | ||||||||
| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331801204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7866232000 | ||||||||
| FaxNumber: | 7862214276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2009 | ||||||||
| LastUpdateDate: | 01/13/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MT195641 | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | ME125095 | FL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0117X | ME125095 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | ME125095 | 01 | FL | FLORIDA STATE BOARD OF MEDICINE | OTHER | MT195641 | 01 | PA | PENNSYLVANIA STATE MEDICAL LICENSE | OTHER |