MEDICARE: BURAKOVSKIY DPM PC

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	213E00000X	Podiatrist	PO 00000808	WA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	PO60255094	WA
3	332900000X	Non-Pharmacy Dispensing Site
4	213ES0103X	Foot & Ankle Surgery Podiatrist	PO00000808	WA

General Provider Information

NPI Number	:	1881777266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURAKOVSKIY DPM PC

Provider Business Mailing Address
First Line	:	13030 121ST WAY NE
Second Line	:	SUITE 204
City	:	KIRKLAND
State	:	WA
Zip	:	98034
Country	:	US
Telephone Number	:	425-822-7426
Fax Number	:	425-827-1717

Provider Business Practice Location Address
First Line	:	13030 121ST WAY NE STE 204
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98034-3008
Country	:	US
Telephone Number	:	425-822-7426
Fax Number	:	425-827-1717

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	MR. MIKHAIL BURAKOVSKIY
Credential	:	DPM
Telephone Number	:	425-822-7426

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/07/2023

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Directions to “BURAKOVSKIY DPM PC ” Practice Location

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