Provider Demographics
NPI:1619089182
Name:MIKHAYLOV, ARTUR (MD)
Entity type:Individual
Prefix:
First Name:ARTUR
Middle Name:
Last Name:MIKHAYLOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 VAN DAM ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3523
Mailing Address - Country:US
Mailing Address - Phone:516-812-9494
Mailing Address - Fax:
Practice Address - Street 1:6254 97TH PL STE 2B
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1354
Practice Address - Country:US
Practice Address - Phone:718-595-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226007208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH75327Medicare UPIN