Provider Demographics
NPI:1558473256
Name:LYUBICH, MIKHAIL (MD PC)
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:
Last Name:LYUBICH
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3032
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-0052
Mailing Address - Country:US
Mailing Address - Phone:678-532-9044
Mailing Address - Fax:404-521-9261
Practice Address - Street 1:340 BOULEVARD NE
Practice Address - Street 2:SUITE324
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1283
Practice Address - Country:US
Practice Address - Phone:404-523-1864
Practice Address - Fax:404-521-9261
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61273322207R00000X
GA0044779207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDVWHMedicare PIN
GAG76649Medicare UPIN