Provider Demographics
NPI:1861662496
Name:YAKUBOV, MIKHAIL (DO)
Entity Type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:
Last Name:YAKUBOV
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 66TH RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5719 157TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5518
Practice Address - Country:US
Practice Address - Phone:718-463-6467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00841207R00000X
MDH82229207R00000X
IN02004914A207R00000X
MI5101022873207R00000X
VT032.0122521207R00000X
OH34.012471207R00000X
CT55791207R00000X
MEDO2661207R00000X
DEC2-0011981207R00000X
NJ25MB10036300207R00000X
PAOS018620207R00000X
MA269216207R00000X
NY246668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400084216Medicare UPIN
NYG400091614Medicare PIN