Provider Demographics
NPI:1427269182
Name:YULIA VAKSMAN DO AN OPERATING DIVISION OF PROVIDENCE MEDICAL CENTER
Entity type:Organization
Organization Name:YULIA VAKSMAN DO AN OPERATING DIVISION OF PROVIDENCE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-596-4000
Mailing Address - Street 1:PO BOX 12488
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-0488
Mailing Address - Country:US
Mailing Address - Phone:913-825-6512
Mailing Address - Fax:913-328-7011
Practice Address - Street 1:8919 PARALLEL PKWY
Practice Address - Street 2:STE 580
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1636
Practice Address - Country:US
Practice Address - Phone:913-788-9797
Practice Address - Fax:913-788-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty