Provider Demographics
NPI:1518699230
Name:PUKHALSKIY, MAKSIM ILICH (DPM)
Entity type:Individual
Prefix:DR
First Name:MAKSIM
Middle Name:ILICH
Last Name:PUKHALSKIY
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 1:3713 SCALLOP CT
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-5213
Mailing Address - Country:US
Mailing Address - Phone:916-923-8490
Mailing Address - Fax:
Practice Address - Street 1:3870 ROSIN CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1620
Practice Address - Country:US
Practice Address - Phone:916-923-8490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE6149213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist