Individual
SERGE RASSKAZOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 S COLUMBIA RD, GRAND FORKS, ND 58201-4012
(701) 780-2300
(701) 780-5772
Mailing address
1200 S COLUMBIA RD, GRAND FORKS, ND 58201-4036
(701) 780-5000
(701) 780-5772
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
036128821
IL
207T00000X
Neurological Surgery Physician
17-719
ZZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366716466
—
MI
Enumeration date
03/07/2012
Last updated
04/12/2018
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