Provider Demographics
NPI:1568132884
Name:KAYUMOV, MIKHAIL
Entity Type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:
Last Name:KAYUMOV
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 1:10025 QUEENS BLVD APT 7R
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2461
Mailing Address - Country:US
Mailing Address - Phone:917-272-4771
Mailing Address - Fax:
Practice Address - Street 1:10025 QUEENS BLVD APT 7R
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2461
Practice Address - Country:US
Practice Address - Phone:917-272-4771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RJ12340183500000X
NY068807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist