MEDICARE: ISAAC ZINOVY PUGACH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	M4454	TX

General Provider Information

NPI Number	:	1255412409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAAC ZINOVY PUGACH M.D.

Provider Business Mailing Address
First Line	:	660 N CENTRAL EXPY STE 640
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-6856
Country	:	US
Telephone Number	:	972-792-7777
Fax Number	:	469-969-0090

Provider Business Practice Location Address
First Line	:	660 N CENTRAL EXPY STE 640
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-6856
Country	:	US
Telephone Number	:	972-792-7777
Fax Number	:	469-969-0090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/19/2021

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