Provider Demographics
NPI:1861758385
Name:BELOUSOV, YEKATERINA N (DO)
Entity type:Individual
Prefix:
First Name:YEKATERINA
Middle Name:N
Last Name:BELOUSOV
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:954-965-7331
Mailing Address - Fax:954-965-7339
Practice Address - Street 1:21097 NE 27TH CT
Practice Address - Street 2:SUITE 205
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1204
Practice Address - Country:US
Practice Address - Phone:305-682-9877
Practice Address - Fax:305-682-1602
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2020-05-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS13264208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014888100Medicaid