Provider Demographics
NPI:1063043503
Name:FOREFRONT MEDICAL SOLUTIONS, LLC.
Entity Type:Organization
Organization Name:FOREFRONT MEDICAL SOLUTIONS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKOVICHIK
Authorized Official - Suffix:
Authorized Official - Credentials:ABPMR, ABIHM
Authorized Official - Phone:972-365-9842
Mailing Address - Street 1:7401 BOCA RATON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-3265
Mailing Address - Country:US
Mailing Address - Phone:214-271-7510
Mailing Address - Fax:972-692-8124
Practice Address - Street 1:7401 BOCA RATON DR
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-3265
Practice Address - Country:US
Practice Address - Phone:214-271-7510
Practice Address - Fax:972-692-8124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1982868899OtherNPI