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NPI Code Detail

MEDICARE: DR. ALEXANDER YUDOVICH M.D.

MEDICARE: DR. ALEXANDER YUDOVICH M.D.
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
1208000000XPediatrics PhysicianQ0389TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508125923
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALEXANDER YUDOVICH M.D.
Provider Business Mailing Address
First Line : 4501 GROVEWAY DR
Second Line :
City : HOUSTON
State : TX
Zip : 77087-1122
Country : US
Telephone Number : 713-644-1568
Fax Number :
Provider Business Practice Location Address
First Line : 4501 GROVEWAY DR
Second Line :
City : HOUSTON
State : TX
Zip : 77087-1122
Country : US
Telephone Number : 713-644-1568
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2012
Last Update Date : 12/08/2015

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