Provider Demographics
NPI:1407199185
Name:KOSTIOUKHINA, EKATERINA (MD)
Entity Type:Individual
Prefix:DR
First Name:EKATERINA
Middle Name:
Last Name:KOSTIOUKHINA
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 1:5301 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1149
Mailing Address - Country:US
Mailing Address - Phone:561-548-1273
Mailing Address - Fax:561-548-1572
Practice Address - Street 1:180 JFK DR
Practice Address - Street 2:SUITE 210
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6607
Practice Address - Country:US
Practice Address - Phone:561-548-1450
Practice Address - Fax:561-548-1459
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016038202207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine