MEDICARE: VERA G ALTUKHOV L. M. T

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	174400000X	Specialist	MA60161808	WA

General Provider Information

NPI Number	:	1760779821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERA G ALTUKHOV L. M. T

Provider Business Mailing Address
First Line	:	5625 N WALL ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99205-6435
Country	:	US
Telephone Number	:	509-482-1982
Fax Number	:	509-482-1983

Provider Business Practice Location Address
First Line	:	5625 N WALL ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99205-6435
Country	:	US
Telephone Number	:	509-482-1982
Fax Number	:	509-482-1983

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

Provider Enumeration Date	:	07/08/2011
Last Update Date	:	07/08/2011

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