1881777266 NPI NUMBER - BURAKOVSKIY, DPM PC

Summary

Detailed Information

NPI Number 1881777266 is assigned to an organization registered under the healthcare provider name BURAKOVSKIY, DPM PC .
The provider is doing business as INTEGRATIVE FOOT AND ANKLE CENTERS OF WASHINGTON .
The provider is a MULTIPLE SINGLE SPECIALTY GROUP .

The provider is physically located at:

13030 121ST WAY NE
SUITE 204
KIRKLAND, WA
ZIP 98034
Phone: (425) 822-7426
Fax: (425) 827-1717

The provider's authorized official is MIKHAIL BURAKOVSKIY .
The authorized official title is OWNER/PROVIDER and has the following contact phone number (425) 822-7426 .

The enumeration date for this NPI number is 10/23/2006 and was last updated on 2/22/2013 .

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License Number State
1	213E00000X	Podiatrist		PO 00000808	WA	View Code
2	213ES0103X	Podiatrist	Foot & Ankle Surgery	PO00000808	WA	View Code
3	213ES0103X	Podiatrist	Foot & Ankle Surgery	PO60255094	WA	View Code

Other (Legacy) Identifiers

The following legacy identifiers for this provider are available:

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	G8861813	MEDICARE PIN	WA
2	5833760004	MEDICARE NSC	WA

NPI Record

No.	Field Name	Field Value
1	NPI	1881777266
2	Entity Type Code	2
3	Employer Identification Number EIN
4	Provider Organization Name Legal Business Name	BURAKOVSKIY, DPM PC
5	Provider Other Organization Name	INTEGRATIVE FOOT AND ANKLE CENTERS OF WASHINGTON
6	Provider Other Organization Name Type Code	3
7	Provider First Line Business Practice Location Address	13030 121ST WAY NE
8	Provider Second Line Business Practice Location Address	SUITE 204
9	Provider Business Practice Location Address City Name	KIRKLAND
10	Provider Business Practice Location Address State Name	WA
11	Provider Business Practice Location Address Postal Code	98034
12	Provider Business Practice Location Address Country Code If outside U S	US
13	Provider Business Practice Location Address Telephone Number	4258227426
14	Provider Business Practice Location Address Fax Number	4258271717
15	Provider Enumeration Date	10/23/2006
16	Last Update Date	2/22/2013
17	Authorized Official Last Name	BURAKOVSKIY
18	Authorized Official First Name	MIKHAIL
19	Authorized Official Title or Position	OWNER/PROVIDER
20	Authorized Official Telephone Number	4258227426
21	Healthcare Provider Taxonomy Code 1	213E00000X
22	Provider License Number 1	PO 00000808
23	Provider License Number State Code 1	WA
24	Healthcare Provider Primary Taxonomy Switch 1	N
25	Healthcare Provider Taxonomy Code 2	213ES0103X
26	Provider License Number 2	PO00000808
27	Provider License Number State Code 2	WA
28	Healthcare Provider Primary Taxonomy Switch 2	Y
29	Healthcare Provider Taxonomy Code 3	213ES0103X
30	Provider License Number 3	PO60255094
31	Provider License Number State Code 3	WA
32	Healthcare Provider Primary Taxonomy Switch 3	N
33	Other Provider Identifier 1	G8861813
34	Other Provider Identifier Type Code 1	08
35	Other Provider Identifier State 1	WA
36	Other Provider Identifier 2	5833760004
37	Other Provider Identifier Type Code 2	07
38	Other Provider Identifier State 2	WA
39	Is Organization Subpart	N
40	Authorized Official Name Prefix Text	MR.
41	Authorized Official Credential Text	DPM
42	Healthcare Provider Taxonomy Group 1	193400000X MULTIPLE SINGLE SPECIALTY GROUP
43	Healthcare Provider Taxonomy Group 2	193400000X MULTIPLE SINGLE SPECIALTY GROUP
44	Healthcare Provider Taxonomy Group 3	193400000X MULTIPLE SINGLE SPECIALTY GROUP

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This page was last updated on: 5/14/2013
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.