Provider Demographics
NPI:1326028705
Name:RAKHMANINE, MIKHAIL I (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:I
Last Name:RAKHMANINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1255 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 3900
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6256
Mailing Address - Country:US
Mailing Address - Phone:484-788-0852
Mailing Address - Fax:610-435-5003
Practice Address - Street 1:1255 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 3900
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6256
Practice Address - Country:US
Practice Address - Phone:610-402-1095
Practice Address - Fax:610-435-5003
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068200L208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001843937000Medicaid
PAH39522Medicare UPIN
PAH39522Medicare UPIN