Healthcare Provider Details

I. General information

NPI: 1356507636
Provider Name (Legal Business Name): SIARHEI SLINKO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SERGEI SLINKO MD

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N MICHIGAN ST FL 5
SOUTH BEND IN
46601-1033
US

IV. Provider business mailing address

710 N NILES AVE
SOUTH BEND IN
46617-1924
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-7275
  • Fax:
Mailing address:
  • Phone: 574-647-1610
  • Fax: 574-237-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number01087405A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: