Provider Demographics
NPI:1083601355
Name:PERSHMAN, YULIY MUKH (MD)
Entity Type:Individual
Prefix:DR
First Name:YULIY
Middle Name:MUKH
Last Name:PERSHMAN
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 1:9252 N GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53209-1104
Mailing Address - Country:US
Mailing Address - Phone:414-527-5089
Mailing Address - Fax:414-365-6349
Practice Address - Street 1:9252 N GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53209-1104
Practice Address - Country:US
Practice Address - Phone:414-527-5089
Practice Address - Fax:414-365-6349
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43729-020208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI041968480OtherMEDICARE PTAN
WI046173840OtherMEDICARE PTAN
WIH45789Medicare UPIN