Provider Demographics
NPI:1518030535
Name:MIKHAIL, PETER S (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:S
Last Name:MIKHAIL
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 1:7657 CITA LN
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6221
Mailing Address - Country:US
Mailing Address - Phone:940-597-6339
Mailing Address - Fax:727-312-4841
Practice Address - Street 1:7657 CITA LN
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6221
Practice Address - Country:US
Practice Address - Phone:940-764-5400
Practice Address - Fax:940-764-5410
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101248063208G00000X
101YS0200X
TXP4594208G00000X
ARE12623208G00000X
MI4301500326208G00000X
FLME95264208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278602800Medicaid
VA1518030535Medicaid
FLAE987ZMedicare PIN
FLAE987YMedicare PIN
VAVAA103139Medicare PIN