Provider Demographics
NPI:1255412409
Name:PUGACH, ISAAC ZINOVY (MD)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:ZINOVY
Last Name:PUGACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ZINOVY
Other - Middle Name:
Other - Last Name:PUGACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:660 N CENTRAL EXPY STE 640
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6856
Mailing Address - Country:US
Mailing Address - Phone:972-792-7777
Mailing Address - Fax:469-969-0090
Practice Address - Street 1:660 N CENTRAL EXPY STE 640
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6856
Practice Address - Country:US
Practice Address - Phone:972-792-7777
Practice Address - Fax:469-969-0090
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI00275Medicare UPIN