Provider Demographics
NPI:1467437889
Name:PUGLIESE, PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:PUGLIESE
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 1:16800 NW 2ND AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:N MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5501
Mailing Address - Country:US
Mailing Address - Phone:305-690-3718
Mailing Address - Fax:305-690-4875
Practice Address - Street 1:16800 NW 2ND AVE STE 400
Practice Address - Street 2:
Practice Address - City:N MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5501
Practice Address - Country:US
Practice Address - Phone:305-690-3718
Practice Address - Fax:305-690-4875
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65294207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD79523Medicare UPIN
FL25480Medicare ID - Type Unspecified