Individual
RUSLAN KHAMITOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4619 CRESTVIEW LN, LAKELAND, FL 33813-2415
(863) 944-6935
Mailing address
4619 CRESTVIEW LANE, LAKELAND, FL 33813-2415
(863) 944-6935
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
15-284
CO
Other
Enumeration date
01/09/2017
Last updated
01/09/2017
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