| Kenvelo2 | |
|
66 W Flagler St Ste 900 Miami FL 33130-1807 | |
| (414) 915-5665 | |
| Not Available |
| Full Name | Kenvelo2 |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 66 W Flagler St Ste 900, Miami, Florida |
| Authorized Official Name and Position | Eduard Tsyrulnykov (OWNER) |
| Authorized Official Contact | 4149155665 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenvelo2 66 W Flagler St Ste 900 Miami FL 33130-1807 Ph: (414) 915-5665 | Kenvelo2 66 W Flagler St Ste 900 Miami FL 33130-1807 Ph: (414) 915-5665 |
| NPI Number | 1184353310 |
|---|---|
| Provider Enumeration Date | 06/04/2022 |
| Last Update Date | 08/21/2023 |
| Medicare PECOS PAC ID | 5294190740 |
|---|---|
| Medicare Enrollment ID | O20230505000413 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184353310 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Eduard Tsyrulnykov |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720213812 PECOS PAC ID: 8527489855 Enrollment ID: I20211214002351 |
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