Provider Demographics
NPI:1790989150
Name:TIKHOMIROV, VSEVOLOD (MD)
Entity Type:Individual
Prefix:
First Name:VSEVOLOD
Middle Name:
Last Name:TIKHOMIROV
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 1:801 MACARTHUR BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2915
Mailing Address - Country:US
Mailing Address - Phone:219-836-4220
Mailing Address - Fax:219-836-4171
Practice Address - Street 1:801 MACARTHUR BLVD
Practice Address - Street 2:STE 204
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2915
Practice Address - Country:US
Practice Address - Phone:219-836-4220
Practice Address - Fax:219-836-4171
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01071523A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)