Provider Demographics
NPI:1598749178
Name:AZRILEVICH, MIKHAIL LOSIF (MD)
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:LOSIF
Last Name:AZRILEVICH
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 1:9922 ROOSEVELT BLVD.
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1704
Mailing Address - Country:US
Mailing Address - Phone:215-464-6040
Mailing Address - Fax:215-464-6046
Practice Address - Street 1:9922 ROOSEVELT BLVD.
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1704
Practice Address - Country:US
Practice Address - Phone:215-676-2741
Practice Address - Fax:215-676-2796
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062068L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001663133Medicaid
PA110150740OtherRAILROAD MEDICARE
PA2Y3072OtherHEALTH NET
PA2871OtherBRAVO HEALTH
PA30033849OtherKEYSTONE MERCY HEALTH PLA
PA5615579OtherAETNA PPO
PA117016OtherHIGHMARK BLUE SHIELD
PA0166313302OtherAMERICHOICE
PA0866629OtherAETNA HMO
PA546193OtherCOVENTRY HEALTH AMERICA
PAP945996OtherOXFORD
PA0131367000OtherINDEPENDENCE BLUE CROSS
PA2Y3072OtherHEALTH NET
PA30033849OtherKEYSTONE MERCY HEALTH PLA
PA2871OtherBRAVO HEALTH