Provider Demographics
NPI:1548474448
Name:MIGUEL PUPIALES MD PC
Entity type:Organization
Organization Name:MIGUEL PUPIALES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PUPIALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-350-8331
Mailing Address - Street 1:PO BOX 16680
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87191-6680
Mailing Address - Country:US
Mailing Address - Phone:505-344-7246
Mailing Address - Fax:505-344-2666
Practice Address - Street 1:4163 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6742
Practice Address - Country:US
Practice Address - Phone:505-344-7246
Practice Address - Fax:505-344-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM200-92207LP2900X
NM2000-92208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM6703900001Medicare NSC
NMH05416Medicare UPIN
NM900521512Medicare PIN