Provider Demographics
NPI:1659337111
Name:MARKEWYCH, BORYS E (DPM)
Entity Type:Individual
Prefix:DR
First Name:BORYS
Middle Name:E
Last Name:MARKEWYCH
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 1:3707 S GRAND BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2712
Mailing Address - Country:US
Mailing Address - Phone:509-747-0274
Mailing Address - Fax:509-747-3220
Practice Address - Street 1:3707 S GRAND BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2712
Practice Address - Country:US
Practice Address - Phone:509-747-0274
Practice Address - Fax:509-747-3220
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP000000376213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1019819Medicaid
G000301956Medicare ID - Type Unspecified
WA0353610001Medicare NSC
WA1019819Medicaid