Provider Demographics
NPI:1598095929
Name:IVANUKOFF, VICTORIA (DO)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:IVANUKOFF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1035 SOUTHCREST DR
Mailing Address - Street 2:STE 250
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6117
Mailing Address - Country:US
Mailing Address - Phone:770-996-9945
Mailing Address - Fax:844-269-9596
Practice Address - Street 1:1532 LONE OAK RD STE 405
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7942
Practice Address - Country:US
Practice Address - Phone:270-441-4300
Practice Address - Fax:270-441-4370
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2019-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0766432086S0129X
KY044872086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery