Healthcare Provider Details

I. General information

NPI: 1376960203
Provider Name (Legal Business Name): SERGEY KUHAREVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SIARHEI VATSLAVOVICH KUKHAREVICH

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MILL ST
RENO NV
89502-1576
US

IV. Provider business mailing address

1155 MILL ST # MSM14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-7878
  • Fax: 775-982-4196
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number70923
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberCDR.0001358
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number17004
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number17004
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: