Provider Demographics
NPI:1831192657
Name:BAKULE, PAUL T (MD P A)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:T
Last Name:BAKULE
Suffix:
Gender:M
Credentials:MD P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:787 37TH ST
Mailing Address - Street 2:STE E130
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7313
Mailing Address - Country:US
Mailing Address - Phone:772-562-2524
Mailing Address - Fax:772-562-2286
Practice Address - Street 1:787 37TH ST
Practice Address - Street 2:STE E130
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7313
Practice Address - Country:US
Practice Address - Phone:772-562-2524
Practice Address - Fax:772-562-2286
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME17740208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31066OtherBLUE CROSS BLUE SHIELD
FL340018891OtherMEDICARE RAILROAD
FL051040800Medicaid
FLD54199Medicare UPIN
FL31066BMedicare ID - Type Unspecified