Provider Demographics
NPI:1225681042
Name:SHOROKHOV, IGOR
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:SHOROKHOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8516 DIANTHUS CT UNIT 204
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3989
Mailing Address - Country:US
Mailing Address - Phone:440-313-9246
Mailing Address - Fax:
Practice Address - Street 1:8516 DIANTHUS CT UNIT 204
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3989
Practice Address - Country:US
Practice Address - Phone:440-313-9246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-21
Last Update Date:2019-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No347B00000XTransportation ServicesBus