Provider Demographics
NPI:1124012786
Name:KINACHTCHOUK, LIOUDMILA (MD)
Entity Type:Individual
Prefix:
First Name:LIOUDMILA
Middle Name:
Last Name:KINACHTCHOUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 TOWNE CENTRE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2818
Mailing Address - Country:US
Mailing Address - Phone:989-790-2984
Mailing Address - Fax:989-790-2983
Practice Address - Street 1:4705 TOWNE CTR
Practice Address - Street 2:SUITE 102
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2818
Practice Address - Country:US
Practice Address - Phone:989-790-2984
Practice Address - Fax:989-790-2983
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILK061473207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4564845Medicaid
MI4564845Medicaid
MI0N81490Medicare PIN