Healthcare Provider Details

I. General information

NPI: 1124097142
Provider Name (Legal Business Name): ARTHUR LYAKHOVETSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 ADAMS ST
HOLLYWOOD FL
33019-1803
US

IV. Provider business mailing address

1410 BALLOU RD
FLOYDS KNOBS IN
47119-8523
US

V. Phone/Fax

Practice location:
  • Phone: 317-414-7372
  • Fax:
Mailing address:
  • Phone: 502-794-6852
  • Fax: 877-215-4462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number01042262B
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number01047262A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: