=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841338993
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIKHAIL VLADIMIR MAKOVSKI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2007
-----------------------------------------------------
Last Update Date | 08/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6719 S 211TH ST SUITE 102
-----------------------------------------------------
City | KENT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-656-0223
-----------------------------------------------------
Fax | 253-872-7900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 749958
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90074-9958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-656-0223
-----------------------------------------------------
Fax | 253-872-7900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207UN0903X
-----------------------------------------------------
Taxonomy Name | In Vivo & In Vitro Nuclear Medicine Physician
-----------------------------------------------------
License Number | MD00039986
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------