Provider Demographics
NPI:1407241524
Name:DRANNIKOV, EDUARD (MD)
Entity Type:Individual
Prefix:
First Name:EDUARD
Middle Name:
Last Name:DRANNIKOV
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 1:18818 TELLER AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-8884
Mailing Address - Country:US
Mailing Address - Phone:949-535-2322
Mailing Address - Fax:
Practice Address - Street 1:18818 TELLER AVE STE 170
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-8884
Practice Address - Country:US
Practice Address - Phone:949-535-2322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA150694207Q00000X
MI4301115855207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine