Provider Demographics
NPI:1942949359
Name:BURLACHKO, ALEXANDRER
Entity Type:Individual
Prefix:
First Name:ALEXANDRER
Middle Name:
Last Name:BURLACHKO
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 1:439 BURDICK CT
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-2663
Mailing Address - Country:US
Mailing Address - Phone:828-280-7326
Mailing Address - Fax:
Practice Address - Street 1:2402 30TH AVE S APT 218
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6580
Practice Address - Country:US
Practice Address - Phone:701-317-3596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker