Provider Demographics
NPI:1841522166
Name:SCHARAFANOW, VLADIMIR JOSEPH (MT)
Entity type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:JOSEPH
Last Name:SCHARAFANOW
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 LAKE ST S
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2616
Mailing Address - Country:US
Mailing Address - Phone:651-464-1113
Mailing Address - Fax:651-464-0853
Practice Address - Street 1:967 LAKE ST S
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2616
Practice Address - Country:US
Practice Address - Phone:651-464-1113
Practice Address - Fax:651-464-0853
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist