Provider Demographics
NPI:1801192703
Name:TIKHONOV, ILYA
Entity Type:Individual
Prefix:
First Name:ILYA
Middle Name:
Last Name:TIKHONOV
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 1:353 NEW LEICESTER HWY STE G
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-2058
Mailing Address - Country:US
Mailing Address - Phone:855-993-0990
Mailing Address - Fax:828-232-9969
Practice Address - Street 1:353 NEW LEICESTER HWY UNIT G
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1512
Practice Address - Country:US
Practice Address - Phone:855-993-0990
Practice Address - Fax:828-232-9969
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies