Healthcare Provider Details

I. General information

NPI: 1780174722
Provider Name (Legal Business Name): MATIAS EDUARDO CZERWONKO PUPI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 TAMPA GENERAL CIR STE 860
TAMPA FL
33606-3573
US

IV. Provider business mailing address

PO BOX 1289
TAMPA FL
33601-1289
US

V. Phone/Fax

Practice location:
  • Phone: 813-660-6950
  • Fax: 813-660-6622
Mailing address:
  • Phone: 813-660-6950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME175363
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: