Provider Demographics
NPI:1902680937
Name:TEMIROV, ISMAIL AKHMADOVICH
Entity Type:Individual
Prefix:
First Name:ISMAIL
Middle Name:AKHMADOVICH
Last Name:TEMIROV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2762 BLUEFLAG ST
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-2583
Mailing Address - Country:US
Mailing Address - Phone:720-250-6494
Mailing Address - Fax:
Practice Address - Street 1:2762 BLUEFLAG ST
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-2583
Practice Address - Country:US
Practice Address - Phone:720-250-6494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant