MEDICARE: VALERIE KOLOKOFF MD

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	207Q00000X	Family Medicine Physician	MD00021494	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	103385	OTHER	WA	L&I

General Provider Information

NPI Number	:	1568494045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE KOLOKOFF MD

Provider Business Mailing Address
First Line	:	5616 S RAVENCREST DR
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-5329
Country	:	US
Telephone Number	:	509-828-9348
Fax Number	:

Provider Business Practice Location Address
First Line	:	GONZAGA UNIVERSITY STUDENT HEALTH 704 E SHARP
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99258
Country	:	US
Telephone Number	:	509-313-4066
Fax Number	:

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	03/27/2019

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