Healthcare Provider Details

I. General information

NPI: 1134669732
Provider Name (Legal Business Name): ALEKSANDR BORISHKEVICH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 E 44TH ST
TACOMA WA
98404-4611
US

IV. Provider business mailing address

1708 E 44TH ST
TACOMA WA
98404-4611
US

V. Phone/Fax

Practice location:
  • Phone: 253-471-4553
  • Fax: 253-474-5395
Mailing address:
  • Phone: 253-471-4553
  • Fax: 253-474-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60908003
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: