MEDICARE: DR. IGOR J KHROMOV 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	208100000X	Physical Medicine & Rehabilitation Physician	ME83110	FL

General Provider Information

NPI Number	:	1578786190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IGOR J KHROMOV MD

Provider Business Mailing Address
First Line	:	2096 38TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-2491
Country	:	US
Telephone Number	:	772-978-9997
Fax Number	:

Provider Business Practice Location Address
First Line	:	2096 38TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-2491
Country	:	US
Telephone Number	:	772-978-9997
Fax Number	:

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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