Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | ME82314 | FL |
NPI | 1003873183 |
---|---|
Provider Name | Boris V Klopukh |
First Address | Fort Myers, FL 33907-1412 |
Second Address | Aventura, FL 33180-1227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 06/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042600 | NHP (01) | FL |
0521542 | CIGNA (01) | FL |
1047823 | CAREPLUS (01) | FL |
11660 | DIMENSION (01) | FL |
14VW0 | BCBS (01) | FL |
1755252 | CIGNA (01) | FL |
244429 | AVMED (01) | FL |
5911548 | AETNA (01) | FL |
61443 | BCBS (01) | FL |
62972 | BCBS (01) | FL |
62972 | BLUE CROSS BLUE SHIELD (01) | FL |
G31534 | (02) | FL |
P01392104 | RR MEDICARE (01) | FL |
P01730006 | SIMPLY HEALTHCARE (01) | FL |
P1017463 | FREEDOM (01) | FL |
P956279 | OPTIMUM (01) | FL |