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NPI Code Detail

MEDICARE: VLADIMIR JOSEPH SCHARAFANOW MT

MEDICARE: VLADIMIR JOSEPH SCHARAFANOW MT
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
1225700000XMassage Therapist

General Provider Information

NPI Number : 1841522166
Entity Type Code : Individual
Provider Name (Legal Business Name) : VLADIMIR JOSEPH SCHARAFANOW MT
Provider Business Mailing Address
First Line : 967 LAKE ST S
Second Line :
City : FOREST LAKE
State : MN
Zip : 55025-2616
Country : US
Telephone Number : 651-464-1113
Fax Number : 651-464-0853
Provider Business Practice Location Address
First Line : 967 LAKE ST S
Second Line :
City : FOREST LAKE
State : MN
Zip : 55025-2616
Country : US
Telephone Number : 651-464-1113
Fax Number : 651-464-0853
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2010
Last Update Date : 02/11/2010

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Directions to “ VLADIMIR JOSEPH SCHARAFANOW MT” Practice Location

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