Healthcare Provider Details

I. General information

NPI: 1376119503
Provider Name (Legal Business Name): ANDRES ARTURO PULIDO WILCHES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE OFC 279WEST
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE OFC 279WEST
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-8178
  • Fax: 305-585-5743
Mailing address:
  • Phone: 305-585-8178
  • Fax: 305-585-5743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME171163
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberME171163
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: