Provider Demographics
NPI:1326102088
Name:BOIKOV, SERGEI G (PHD)
Entity Type:Individual
Prefix:
First Name:SERGEI
Middle Name:G
Last Name:BOIKOV
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19991 HALL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-4254
Mailing Address - Country:US
Mailing Address - Phone:586-263-4401
Mailing Address - Fax:586-263-4402
Practice Address - Street 1:19991 HALL RD
Practice Address - Street 2:STE 102
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-4254
Practice Address - Country:US
Practice Address - Phone:586-263-4401
Practice Address - Fax:586-263-4402
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000211231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
640E014630OtherBCBS