MEDICARE: VLADIMIR GUREVICH L.S.A.

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	363AS0400X	Surgical Physician Assistant	SA00040	TX

General Provider Information

NPI Number	:	1306998000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VLADIMIR GUREVICH L.S.A.

Provider Business Mailing Address
First Line	:	2106 WOODLAND SPRINGS ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-6307
Country	:	US
Telephone Number	:	713-826-1229
Fax Number	:	281-496-3112

Provider Business Practice Location Address
First Line	:	2106 WOODLAND SPRINGS ST.
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-6307
Country	:	US
Telephone Number	:	713-826-1229
Fax Number	:	281-496-3112

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	02/11/2014

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