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NPI Code Detail

MEDICARE: SERGE LARTCHENKO M.D., PLLC

MEDICARE: SERGE LARTCHENKO M.D., PLLC
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
1282N00000XGeneral Acute Care HospitalM8115TX

General Provider Information

NPI Number : 1508199621
Entity Type Code : Organization
Provider Name (Legal Business Name) : SERGE LARTCHENKO M.D., PLLC
Provider Business Mailing Address
First Line : 2320 HUGO ST
Second Line : #1901
City : DALLAS
State : TX
Zip : 75204-2801
Country : US
Telephone Number : 214-300-1364
Fax Number : 214-295-6866
Provider Business Practice Location Address
First Line : 2320 HUGO ST
Second Line : #1901
City : DALLAS
State : TX
Zip : 75204-2801
Country : US
Telephone Number : 214-300-1364
Fax Number : 214-295-6866
Authorized Official
Title or Position : MEMBER
Name : DR. SERGE LARTCHENKO
Credential : M.D.
Telephone Number : 214-300-1364
Provider Enumeration Date : 09/08/2009
Last Update Date : 09/08/2009

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