Provider Demographics
NPI:1891767000
Name:SHIK, MIKHAIL BORIS (MD)
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:BORIS
Last Name:SHIK
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 1:182 INTREPID LN
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2545
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:182 INTREPID LN
Practice Address - Street 2:BRIGHTON MEDICAL ASSOCIATES
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205
Practice Address - Country:US
Practice Address - Phone:315-218-7020
Practice Address - Fax:315-218-7050
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2209921207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02192198Medicaid
NY02192198Medicaid