Provider Demographics
NPI:1306072129
Name:POPINCHALK, SAMUEL PAUL (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:PAUL
Last Name:POPINCHALK
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:21097 NE 27TH CT
Mailing Address - Street 2:SUITE 540
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1204
Mailing Address - Country:US
Mailing Address - Phone:786-623-2000
Mailing Address - Fax:786-221-4276
Practice Address - Street 1:21097 NE 27TH CT
Practice Address - Street 2:SUITE 540
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1204
Practice Address - Country:US
Practice Address - Phone:786-623-2000
Practice Address - Fax:786-221-4276
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT195641207X00000X
FLME125095207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME125095OtherFLORIDA STATE BOARD OF MEDICINE
PAMT195641OtherPENNSYLVANIA STATE MEDICAL LICENSE