Provider Demographics
NPI:1861662496
Name:YAKUBOV, MIKHAIL (DO)
Entity type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:
Last Name:YAKUBOV
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5719 157TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5719 157TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5518
Practice Address - Country:US
Practice Address - Phone:718-463-6467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2024-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0011981207RE0101X
MA269216207RE0101X
RIDO00841207RE0101X
PAOS018620207RE0101X
NJ25MB10036300207RE0101X
NY246668207RE0101X
MEDO2661207RE0101X
CT55791207RE0101X
OH34.012471207RE0101X
VT032.0122521207RE0101X
MDH82229207RE0101X
ARE-16970207RE0101X
WI2819-321207RE0101X
MI5101022873207RE0101X
IN02004914A207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400084216Medicare UPIN
NYG400091614Medicare PIN