Provider Demographics
NPI:1518081595
Name:MIROSHNICHENKO, VICTOR (DPM)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:MIROSHNICHENKO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 W MCNAB RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-3242
Mailing Address - Country:US
Mailing Address - Phone:954-721-1990
Mailing Address - Fax:954-721-1932
Practice Address - Street 1:8333 W MCNAB RD
Practice Address - Street 2:SUITE 116
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-3242
Practice Address - Country:US
Practice Address - Phone:954-721-1990
Practice Address - Fax:954-721-1932
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2442213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU62405Medicare UPIN
FL65370YMedicare PIN