Provider Demographics
NPI:1043714413
Name:MAKSIMCHUK, VLADISLAV (DO)
Entity type:Individual
Prefix:
First Name:VLADISLAV
Middle Name:
Last Name:MAKSIMCHUK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8791 CONFERENCE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5822
Mailing Address - Country:US
Mailing Address - Phone:239-331-5566
Mailing Address - Fax:239-437-7499
Practice Address - Street 1:8791 CONFERENCE DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5822
Practice Address - Country:US
Practice Address - Phone:239-331-5566
Practice Address - Fax:239-437-7499
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS164042085R0202X, 2085R0204X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology