Basic Information
| Provider Information | |||||||||
| NPI: | 1447453824 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ARKADIY V. PURYGIN, M.D., D.O., P.A. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | WOMEN'S HEALTH | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8950 SW 74TH CT | ||||||||
| Address2: | SUITE 1402 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331563171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052714487 | ||||||||
| FaxNumber: | 3059075257 | ||||||||
| Practice Location | |||||||||
| Address1: | 8950 SW 74TH CT | ||||||||
| Address2: | SUITE 1402 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331563171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052714487 | ||||||||
| FaxNumber: | 3059075257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 03/21/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PURYGIN | ||||||||
| AuthorizedOfficialFirstName: | ARKADIY | ||||||||
| AuthorizedOfficialMiddleName: | V. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3052714487 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.O. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | OS 9336 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 29414 | 01 | FL | BCBS | OTHER | 2728231 00 | 05 | FL | MEDICAID | 29414A | 01 | FL | MEDICARE | OTHER |