Provider Demographics
NPI:1558391227
Name:MIKHAIL, DIAA Y (MD)
Entity Type:Individual
Prefix:
First Name:DIAA
Middle Name:Y
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 1:1005 N POINT BLVD
Mailing Address - Street 2:SUITE 708
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3415
Mailing Address - Country:US
Mailing Address - Phone:410-288-5901
Mailing Address - Fax:410-288-5904
Practice Address - Street 1:1005 N POINT BLVD
Practice Address - Street 2:SUITE 708
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3415
Practice Address - Country:US
Practice Address - Phone:410-288-5901
Practice Address - Fax:410-288-5904
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0051883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA080188101OtherRAILROAD MEDICARE
DCS344 0001OtherCAREFIRST
MD232113YEG0OtherMEDICARE
MD199301100Medicaid
MDKAV9D1 54847206OtherCAREFIRST
MD232113YEG0OtherMEDICARE