Provider Demographics
NPI:1649238668
Name:ALMAKAEV, ILIAS M SR (MD)
Entity Type:Individual
Prefix:DR
First Name:ILIAS
Middle Name:M
Last Name:ALMAKAEV
Suffix:SR
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 1:351 W SCHUYLKILL RD STE G-15A
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-7438
Mailing Address - Country:US
Mailing Address - Phone:610-326-9460
Mailing Address - Fax:
Practice Address - Street 1:351 W SCHUYLKILL RD STE G-15A
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-7438
Practice Address - Country:US
Practice Address - Phone:610-326-9460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD475995207R00000X
NY237036207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02671603Medicaid
NYI04226Medicare UPIN
NY98S321Medicare ID - Type Unspecified