Provider Demographics
NPI:1174961494
Name:TELEZHENKO, VLADIMIR
Entity type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:TELEZHENKO
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 1:1192 SHARONBROOK DR
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2753
Mailing Address - Country:US
Mailing Address - Phone:216-440-7111
Mailing Address - Fax:
Practice Address - Street 1:1192 SHARONBROOK DR
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2753
Practice Address - Country:US
Practice Address - Phone:216-440-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-09
Last Update Date:2013-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0050725343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0050725Medicaid