Provider Demographics
NPI:1598497299
Name:EFIMENKO, IAKOV VLADISLAVOVICH (MD)
Entity Type:Individual
Prefix:DR
First Name:IAKOV
Middle Name:VLADISLAVOVICH
Last Name:EFIMENKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:IAKOV
Other - Middle Name:VLADISLAVOVICH
Other - Last Name:EFIMENKO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:100 NW 6TH ST APT 1702
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-4132
Mailing Address - Country:US
Mailing Address - Phone:954-461-9452
Mailing Address - Fax:
Practice Address - Street 1:1475 W 49TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3113
Practice Address - Country:US
Practice Address - Phone:305-558-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN36144208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery