Provider Demographics
NPI:1417942590
Name:KAZACHKOV, MIKHAIL (MD)
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:
Last Name:KAZACHKOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E 32ND ST
Mailing Address - Street 2:L3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6004
Mailing Address - Country:US
Mailing Address - Phone:212-263-5940
Mailing Address - Fax:212-263-9678
Practice Address - Street 1:160 E 32ND ST
Practice Address - Street 2:L3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6004
Practice Address - Country:US
Practice Address - Phone:212-263-5940
Practice Address - Fax:212-263-9678
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2197112080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY219711-A15OtherHEALTH FIRST
NY7535054OtherAETNA PPO
NY82N0231OtherNEIGHBORHOOD HEALTH
NY01995564Medicaid
NY2603103OtherGHI
NY2597368OtherAETNA USHC HMO
NY219711OtherHIP
NY2C9630OtherHEALTH NET
NYP2214173OtherOXFORD HEALTH PLAN
NY113491197OtherMULTIPLAN
NY113491197OtherPHCS
NY2105115-10OtherUNITED HEALTH CARE
NY344630101OtherHEALTH PLUS
NYKM9711OtherATLANTIS HEALTH
NY0100149-02OtherAMERICHOICE
NY1Q6441OtherEMPIRE BCBS
NYKM9711OtherATLANTIS HEALTH
NY7535054OtherAETNA PPO