Provider Demographics
NPI:1083639561
Name:VAYSBERG, MIKHAIL (DO)
Entity type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:
Last Name:VAYSBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:MIKHAIL
Other - Middle Name:
Other - Last Name:VAYSBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:7560 RED BUG LAKE RD STE 1014
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6591
Mailing Address - Country:US
Mailing Address - Phone:407-706-1770
Mailing Address - Fax:407-706-1777
Practice Address - Street 1:7560 RED BUG LAKE RD STE 1014
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6591
Practice Address - Country:US
Practice Address - Phone:407-706-1770
Practice Address - Fax:407-706-1777
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008737174400000X
FLOS10139207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278754700Medicaid
FL278754700Medicaid