Provider Demographics
NPI:1497144695
Name:DVORKIN, MIKHAIL
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:
Last Name:DVORKIN
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 1:9450 E MISSISSIPPI AVE UNIT F
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2427
Mailing Address - Country:US
Mailing Address - Phone:720-271-0914
Mailing Address - Fax:
Practice Address - Street 1:9450 E MISSISSIPPI AVE UNIT F
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-2427
Practice Address - Country:US
Practice Address - Phone:720-271-0914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO201511024023332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20151024023OtherMEDICAL SUPPLY