Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO3522 | FL |
NPI | 1053572511 |
---|---|
Provider Name | Dr. Vyacheslav Makarov |
First Address | Sunny Isles Beach, FL 33160-3311 |
Second Address | North Miami Beach, FL 33179-4845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2008 |
Last Update Date | 09/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007138400 | (05) | FL |