BURAKOVSKIY, DPM PC (INTEGRATIVE FOOT AND ANKLE CENTERS OF WASHINGTON) - NPI NUMBER 1881777266

Summary

Provider Name: BURAKOVSKIY, DPM PC (INTEGRATIVE FOOT AND ANKLE CENTERS OF WASHINGTON)

NPI Number: 1881777266

Clasification: Podiatrist (213E00000X)

Address:
13030 121ST WAY NE
SUITE 204
KIRKLAND, WA
ZIP 98034

Phone Number: (425) 822-7426



Detailed Information

BURAKOVSKIY, DPM PC is a podiatrist in Kirkland, WA. The provider is a podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. The assigned NPI number for this provider is 1881777266 and is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Integrative Foot And Ankle Centers Of Washington.

The provider's business address is:

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

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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 State Primary
1 213E00000X Podiatrist PO 00000808 WA No
2 213ES0103X Podiatrist Foot & Ankle Surgery PO00000808 WA Yes
3 213ES0103X Podiatrist Foot & Ankle Surgery PO60255094 WA No

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

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: 10/12/2014
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.