Provider Demographics
NPI:1184628570
Name:PULLEKINES, JOSEPH WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:PULLEKINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-6140
Mailing Address - Fax:864-512-6149
Practice Address - Street 1:100 HEALTHY WAY STE 1250
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-7917
Practice Address - Country:US
Practice Address - Phone:864-512-6140
Practice Address - Fax:864-512-6149
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44911207X00000X
PA042873-E207X00000X
SC52367207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP014232842OtherRR MEDICARE
SC523678Medicaid
PA0014029600001Medicaid
KY7100190690Medicaid
KYK036860OtherMEDICARE PTAN