Provider Demographics
NPI:1154719060
Name:ZAKHARCHUK, RUSLAN ZENO (PA)
Entity type:Individual
Prefix:
First Name:RUSLAN
Middle Name:ZENO
Last Name:ZAKHARCHUK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 MAYFIELD RD
Mailing Address - Street 2:SUITE 537
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2270
Mailing Address - Country:US
Mailing Address - Phone:440-442-4452
Mailing Address - Fax:440-442-0571
Practice Address - Street 1:6801 MAYFIELD ROAD
Practice Address - Street 2:SUITE 537
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:440-442-4452
Practice Address - Fax:440-442-0571
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004223363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50.004223OtherLICENSE NUMBER