Healthcare Provider Details

I. General information

NPI: 1891754909
Provider Name (Legal Business Name): GALINA D ZHURAKOVSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27072 CARRONADE DRIVE BCWC
PERRYSBURG OH
43551-5300
US

IV. Provider business mailing address

P.O. BOX 29 BEHAVIORAL CONNECTIONS OF WOOD COUNTY (BCWC)
BOWLING GREEN OH
43402-0029
US

V. Phone/Fax

Practice location:
  • Phone: 419-872-2419
  • Fax: 419-720-5223
Mailing address:
  • Phone: 419-352-5387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number235539-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.05.3537
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: