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NPI Code Detail

MEDICARE: YURI FEDORENKO MD

MEDICARE: YURI FEDORENKO MD
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
1207R00000XInternal Medicine Physician4301068473MI

General Provider Information

NPI Number : 1134176357
Entity Type Code : Individual
Provider Name (Legal Business Name) : YURI FEDORENKO MD
Provider Business Mailing Address
First Line : 4085 BURTON ST SE
Second Line : S-200
City : GRAND RAPIDS
State : MI
Zip : 49546-2444
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 517 E DIVISION ST
Second Line :
City : ROCKFORD
State : MI
Zip : 49341-1376
Country : US
Telephone Number : 616-974-4884
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2006
Last Update Date : 07/08/2007

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Directions to “ YURI FEDORENKO MD” Practice Location

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