Provider Demographics
NPI:1255320461
Name:MITZOV, NIKOLAY P (MD)
Entity Type:Individual
Prefix:MR
First Name:NIKOLAY
Middle Name:P
Last Name:MITZOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:11375 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5409
Mailing Address - Country:US
Mailing Address - Phone:352-597-6007
Mailing Address - Fax:352-597-6031
Practice Address - Street 1:11375 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5409
Practice Address - Country:US
Practice Address - Phone:352-597-6007
Practice Address - Fax:352-597-6031
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056818A207R00000X
FLME 97001207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INH83243Medicare UPIN