MEDICARE: ELENA KAZAKOVA PA-C

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	363A00000X	Physician Assistant	9105687	FL

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

General Provider Information

NPI Number	:	1811296197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA KAZAKOVA PA-C

Provider Business Mailing Address
First Line	:	1945 S OCEAN DR APT 214
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-6077
Country	:	US
Telephone Number	:	305-331-6128
Fax Number	:

Provider Business Practice Location Address
First Line	:	1945 S OCEAN DR APT 214
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-6077
Country	:	US
Telephone Number	:	305-331-6128
Fax Number	:

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

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	04/26/2021

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Directions to “ ELENA KAZAKOVA PA-C” Practice Location

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