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General NPI Number Information
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NPI Number | 1427219583
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Entity Type | Individual
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Provider Name | ALEXANDRA LUKIANOFF MD
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Gender | Female
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Dates
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Enumeration Date | 06/21/2008
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 101 WESTPARK DR STE 240
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City | BRENTWOOD
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State | TN
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Zip | 37027-5643
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Country | US
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Telephone | 860-906-8515
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 848388
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City | BOSTON
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State | MA
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Zip | 02284-8388
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Country | US
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Telephone | 860-533-2903
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Fax | 860-533-2928
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 61098
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License Number State | TN
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