MEDICARE: YULIA LIFITS-PODOROZHANSKY 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
1	207V00000X	Obstetrics & Gynecology Physician	2005040723	MO
2	207VG0400X	Gynecology Physician	2005040723	MO
3	207VX0000X	Obstetrics Physician	2005040723	MO

General Provider Information

NPI Number	:	1689607277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YULIA LIFITS-PODOROZHANSKY M.D.

Provider Business Mailing Address
First Line	:	1203 SMIZER MILL RD
Second Line	:	SUITE 106
City	:	FENTON
State	:	MO
Zip	:	63026-3483
Country	:	US
Telephone Number	:	636-717-1390
Fax Number	:	636-717-1395

Provider Business Practice Location Address
First Line	:	1203 SMIZER MILL RD
Second Line	:	SUITE 106
City	:	FENTON
State	:	MO
Zip	:	63026-3483
Country	:	US
Telephone Number	:	636-717-1390
Fax Number	:	636-717-1395

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	01/25/2012

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