Individual
DR. ROBERT PUCHALSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15 EXCHANGE DR, LUGOFF, SC 29078-9198
(803) 408-3277
(803) 408-3299
Mailing address
PO BOX 520, LUGOFF, SC 29078-0520
(803) 408-3277
(803) 408-3299
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
23048
SC
207YS0012X
Sleep Medicine (Otolaryngology) Physician
Primary
23048
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
230486
—
SC
01
—
DE5192
UNSPECIFIED
SC
Enumeration date
07/12/2006
Last updated
05/26/2020
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