Basic Information
| Provider Information | |||||||||
| NPI: | 1407803893 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PYLMAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8524 W GAGE BLVD | ||||||||
| Address2: | BLDG A1 BOX 319 | ||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993368241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095910070 | ||||||||
| FaxNumber: | 5093969661 | ||||||||
| Practice Location | |||||||||
| Address1: | 3820 COMMONS AVE NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871095831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059337799 | ||||||||
| FaxNumber: | 5097836655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 02/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | MD20589 | OR | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | 13018 | ND | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | MD2015-0259 | NM | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 28838394 | 05 | NM | MEDICAID | 050922021 | 01 | OR | BLUE CROSS | OTHER | 150129 | 05 | OR | MEDICAID | 97420A018 | 01 | OR | TRICARE | OTHER | C105025 | 01 | OR | PACIFIC SOURCE | OTHER | 050087352 | 01 | RAILROAD MEDICARE | OTHER |