Provider Demographics
NPI:1306876966
Name:PUPIALES, MIGUEL A (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:A
Last Name:PUPIALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:630 MANZANO NEST D
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6360
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM2000-92207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH05416Medicare UPIN
NM349716601Medicare PIN