Provider Demographics
NPI:1083820252
Name:KOROGLUYEV, MIKHAIL YURYEVICH (MD,DO)
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:YURYEVICH
Last Name:KOROGLUYEV
Suffix:
Gender:M
Credentials:MD,DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 NATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6917
Mailing Address - Country:US
Mailing Address - Phone:917-873-7907
Mailing Address - Fax:718-889-6091
Practice Address - Street 1:164 BRIGHTON 11TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-407-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine