Provider Demographics
NPI:1033576210
Name:NEZHIVOY, MIKHAIL VIKTOROVICH
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:VIKTOROVICH
Last Name:NEZHIVOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20617 108TH AVE SE APT H17
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-1581
Mailing Address - Country:US
Mailing Address - Phone:253-813-5807
Mailing Address - Fax:
Practice Address - Street 1:20617 108TH AVE SE APT H17
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-1581
Practice Address - Country:US
Practice Address - Phone:253-813-5807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program