Provider Demographics
NPI:1376547604
Name:MIKHLI, ALLA (DPM)
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:MIKHLI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SOM CENTER RD STE 350
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2362
Mailing Address - Country:US
Mailing Address - Phone:440-995-1111
Mailing Address - Fax:
Practice Address - Street 1:730 SOM CENTER RD STE 350
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2362
Practice Address - Country:US
Practice Address - Phone:440-995-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002690213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist