Provider Demographics
NPI:1154841922
Name:KOLGANOV, MYKOLA (MD)
Entity Type:Individual
Prefix:
First Name:MYKOLA
Middle Name:
Last Name:KOLGANOV
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:PO BOX 5023
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-0023
Mailing Address - Country:US
Mailing Address - Phone:626-200-8714
Mailing Address - Fax:
Practice Address - Street 1:2351 E 22ND ST STE 338W
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3111
Practice Address - Country:US
Practice Address - Phone:216-861-6200
Practice Address - Fax:216-363-7490
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.029851207R00000X
OH35.139019207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine