MEDICARE: VASYL SOROKHAN M.D., PH.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	207Q00000X	Family Medicine Physician	57.012895	OH

General Provider Information

NPI Number	:	1053517052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VASYL SOROKHAN M.D., PH.D.

Provider Business Mailing Address
First Line	:	11651 NORBOURNE DR
Second Line	:	APT. 1117
City	:	CINCINNATI
State	:	OH
Zip	:	45240-2100
Country	:	US
Telephone Number	:	248-915-9646
Fax Number	:

Provider Business Practice Location Address
First Line	:	1295 KEMPER MEADOW DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-1633
Country	:	US
Telephone Number	:	513-648-9077
Fax Number	:	513-345-6665

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

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	07/08/2007

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