Provider Demographics
NPI:1487187753
Name:YEVTUKH, SERGEY
Entity Type:Individual
Prefix:MR
First Name:SERGEY
Middle Name:
Last Name:YEVTUKH
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 1:6620 GROVE LN
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-6960
Mailing Address - Country:US
Mailing Address - Phone:440-533-5659
Mailing Address - Fax:
Practice Address - Street 1:6620 GROVE LN
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-6960
Practice Address - Country:US
Practice Address - Phone:440-533-5659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide