Provider Demographics
NPI:1144801523
Name:SUKHARUTSKI, YAHOR (MD)
Entity Type:Individual
Prefix:
First Name:YAHOR
Middle Name:
Last Name:SUKHARUTSKI
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 1:6051 ROMA DR APT 717
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4673
Mailing Address - Country:US
Mailing Address - Phone:337-529-2413
Mailing Address - Fax:
Practice Address - Street 1:6550 FANNIN ST # SM1001
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-5114
Practice Address - Fax:713-790-3023
Is Sole Proprietor?:No
Enumeration Date:2021-04-18
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00124390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program