MEDICARE: TAMARA BORUKHOV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171WH0202X	Home Modifications Contractor	201562498600SL	CO

General Provider Information

NPI Number	:	1245697416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA BORUKHOV

Provider Business Mailing Address
First Line	:	13057 E COLORADO AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80012-5322
Country	:	US
Telephone Number	:	720-297-7542
Fax Number	:

Provider Business Practice Location Address
First Line	:	13057 E COLORADO AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80012-5322
Country	:	US
Telephone Number	:	720-297-7542
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2016
Last Update Date	:	02/12/2021

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Directions to “ TAMARA BORUKHOV ” Practice Location

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