Provider Demographics
NPI:1215565916
Name:PULGARON, VLADIMIR (MD)
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:PULGARON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VLADIMIR
Other - Middle Name:
Other - Last Name:PULGARON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3101 POPLAR LEVEL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1076
Mailing Address - Country:US
Mailing Address - Phone:502-636-7444
Mailing Address - Fax:502-636-7112
Practice Address - Street 1:3101 POPLAR LEVEL RD STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1076
Practice Address - Country:US
Practice Address - Phone:502-636-7444
Practice Address - Fax:502-636-7112
Is Sole Proprietor?:No
Enumeration Date:2020-03-29
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY57768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program