Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 189446-1 | NY |
NPI | 1003847724 |
---|---|
Provider Name | Dr. Mihael J Puc |
First Address | Syracuse, NY 13203-1807 |
Second Address | Syracuse, NY 13203-1807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01625630 | (05) | NY |
G21938 | (02) | NY |