Individual
DR. ILYA LATYSHENKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
36000 DARNALL LOOP, ATTN: MCXI-DEM, FORT HOOD, TX 76544-5095
(254) 288-8303
(254) 286-7055
Mailing address
36000 DARNALL LOOP, ATTN:MCXI-DEM, FORT HOOD, TX 76544-5095
(254) 288-8303
(254) 286-7055
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2018-00158
NC
Other
Enumeration date
05/25/2013
Last updated
11/27/2023
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