Provider Demographics
NPI:1275877235
Name:PAUL T. BAKULE, MD PA
Entity Type:Organization
Organization Name:PAUL T. BAKULE, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:HELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-562-2524
Mailing Address - Street 1:787 37TH ST STE E130
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7313
Mailing Address - Country:US
Mailing Address - Phone:772-562-2524
Mailing Address - Fax:772-562-2286
Practice Address - Street 1:787 37TH ST STE E130
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7313
Practice Address - Country:US
Practice Address - Phone:772-562-2524
Practice Address - Fax:772-562-2286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME17740208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051040800Medicaid
FL051040800Medicaid
FL31066BMedicare PIN