Provider Demographics
NPI:1902895881
Name:BURAKOVSKIY, MIKHAIL (DPM)
Entity Type:Individual
Prefix:MR
First Name:MIKHAIL
Middle Name:
Last Name:BURAKOVSKIY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13030 121ST WAY NE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-822-7426
Mailing Address - Fax:425-827-1717
Practice Address - Street 1:13030 121ST WAY NE
Practice Address - Street 2:SUITE 204
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-822-7426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006130213E00000X
WAPO00000808213E00000X, 213ES0103X
FLPO4282213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPK1371Medicare ID - Type UnspecifiedEMPIRE MEDICARE SERVICES