Provider Demographics
NPI:1477969533
Name:VISHOVSKI DAYAN, VLADISLAV
Entity Type:Individual
Prefix:MR
First Name:VLADISLAV
Middle Name:
Last Name:VISHOVSKI DAYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30500 NORTHWESTERN HWY STE 316C
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3178
Mailing Address - Country:US
Mailing Address - Phone:248-539-8781
Mailing Address - Fax:248-539-8940
Practice Address - Street 1:30500 NORTHWESTERN HWY STE 316C
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3178
Practice Address - Country:US
Practice Address - Phone:248-539-8781
Practice Address - Fax:248-539-8940
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016755225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist