Provider Demographics
NPI:1003873183
Name:KLOPUKH, BORIS V (MD)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:V
Last Name:KLOPUKH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:21110 BISCAYNE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1227
Practice Address - Country:US
Practice Address - Phone:305-534-4747
Practice Address - Fax:305-937-7726
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2016-10-06
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Provider Licenses
StateLicense IDTaxonomies
FLME82314208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP1017463OtherFREEDOM
FL042600OtherNHP
FL14VW0OtherBCBS
FL5911548OtherAETNA
FLP01730006OtherSIMPLY HEALTHCARE
FL11660OtherDIMENSION
FL1755252OtherCIGNA
FL244429OtherAVMED
FL62972OtherBLUE CROSS BLUE SHIELD
FL61443OtherBCBS
FL1047823OtherCAREPLUS
FL62972OtherBCBS
FLP01392104OtherRR MEDICARE
FL0521542OtherCIGNA
FLP956279OtherOPTIMUM
FL62972OtherBCBS
FLG31534Medicare UPIN
FL042600OtherNHP
FLP01730006OtherSIMPLY HEALTHCARE