Provider Demographics
NPI:1437231081
Name:DRIZIN, MIKHAIL (MD)
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:
Last Name:DRIZIN
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 1:16764 W CHERRYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60083
Mailing Address - Country:US
Mailing Address - Phone:847-395-2389
Mailing Address - Fax:
Practice Address - Street 1:909 E PALATINE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-5551
Practice Address - Country:US
Practice Address - Phone:847-776-1400
Practice Address - Fax:847-776-1424
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069643208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069643Medicaid
ILR01095Medicare PIN
IL036069643Medicaid