Provider Demographics
NPI:1194777029
Name:ERMOLENKO, FELIX (MD)
Entity type:Individual
Prefix:
First Name:FELIX
Middle Name:
Last Name:ERMOLENKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:ATTN: SHMG/HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-7800
Mailing Address - Fax:850-416-4937
Practice Address - Street 1:4451 BAYOU BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2601
Practice Address - Country:US
Practice Address - Phone:850-416-2477
Practice Address - Fax:850-416-7520
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265034700Medicaid
FLP00756972OtherMEDICARE RAILROAD
FL13109VMedicare PIN
FLP00756972OtherMEDICARE RAILROAD
FL13109VMedicare PIN