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Individual
IRAKLI KHULORDAVA
Active
Individual
IRAKLI KHULORDAVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
29322
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
293220
—
SC
01
—
P00137642
RR MEDICARE
SC
Enumeration date
10/20/2006
Last updated
02/07/2019
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