Provider Demographics
NPI:1902138266
Name:RADZIKHOVSKY, ALEXANDER (LMT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:RADZIKHOVSKY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 HILLSBORO MILE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-2801
Mailing Address - Country:US
Mailing Address - Phone:954-257-3095
Mailing Address - Fax:954-785-4425
Practice Address - Street 1:4510 N FEDERAL HWY STE 101
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-6509
Practice Address - Country:US
Practice Address - Phone:954-257-3095
Practice Address - Fax:954-785-4425
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA#0008748174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist