MEDICARE: ROMAN BORUKHOV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	376J00000X	Homemaker
3	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1558122242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMAN BORUKHOV

Provider Business Mailing Address
First Line	:	2620 S BISCAYNE DR
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-4126
Country	:	US
Telephone Number	:	941-416-8308
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 S BISCAYNE DR
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-4126
Country	:	US
Telephone Number	:	941-416-8308
Fax Number	:

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

Provider Enumeration Date	:	01/19/2024
Last Update Date	:	01/19/2024

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Directions to “ ROMAN BORUKHOV ” Practice Location

Language	Start Address	Practice Location

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