Provider Demographics
NPI:1770558454
Name:SENCHENKOV, ALEX (MD)
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:SENCHENKOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3612
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34230
Mailing Address - Country:US
Mailing Address - Phone:507-398-2753
Mailing Address - Fax:941-866-9024
Practice Address - Street 1:2426 S TAMIAMI TRAIL, FLOOR 3
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239
Practice Address - Country:US
Practice Address - Phone:507-398-2753
Practice Address - Fax:941-866-9024
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130013207RE0101X, 207Y00000X, 208200000X, 2082S0099X, 208600000X, 2086X0206X, 2086S0122X
GA77201208200000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107621600Medicaid
MN240000386Medicare PIN
IN200889970Medicaid
MNP00979631OtherMCR RAILROAD MEDICARE
MN443042500Medicaid
PA102219506Medicaid
KY7100030540Medicaid
OH2765664Medicaid
138341Medicare PIN