Provider Demographics
NPI:1841201514
Name:AGAPITOV, ALEXEI VASILIEVICH (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXEI
Middle Name:VASILIEVICH
Last Name:AGAPITOV
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:16650 W BLUEMOUND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5920
Mailing Address - Country:US
Mailing Address - Phone:262-827-9200
Mailing Address - Fax:262-827-9858
Practice Address - Street 1:16650 W BLUEMOUND RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5920
Practice Address - Country:US
Practice Address - Phone:262-827-9200
Practice Address - Fax:262-827-9858
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2015-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI52691-020207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1841201514Medicaid
WI736011932Medicare PIN
WI1841201514Medicaid
WI680860558Medicare PIN
WI685900026Medicare PIN