Provider Demographics
NPI:1043384035
Name:MIKHAIL, MICHAEL M (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:MIKHAIL
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 1:111 SHANDON PL
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3176
Mailing Address - Country:US
Mailing Address - Phone:610-314-3657
Mailing Address - Fax:610-578-0521
Practice Address - Street 1:111 SHANDON PL
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3176
Practice Address - Country:US
Practice Address - Phone:610-314-3657
Practice Address - Fax:610-578-0521
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0069833207RX0202X
PAMD045335L207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00015550830002Medicaid
PA0276947000OtherINDEPENDENCE BLUE CROSS
PA147753OtherBLUE SHIELD
PA00015550830002Medicaid
PA147753P4UMedicare PIN