Provider Demographics
NPI:1619240629
Name:BUHTOIAROV, ILIA NIKOLAEVICH (MD)
Entity Type:Individual
Prefix:DR
First Name:ILIA
Middle Name:NIKOLAEVICH
Last Name:BUHTOIAROV
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 1:9500 EUCLID AVE # R3-118
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-1056
Mailing Address - Country:US
Mailing Address - Phone:216-444-3736
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE # R3-118
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-6007
Practice Address - Country:US
Practice Address - Phone:216-444-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1261182080P0207X, 2080P0207X
NY265486208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics