Provider Demographics
NPI:1922445626
Name:ZAKHAROV, KIRILL (DO)
Entity Type:Individual
Prefix:
First Name:KIRILL
Middle Name:
Last Name:ZAKHAROV
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 1:4185 STILLBROOK LN
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-7889
Mailing Address - Country:US
Mailing Address - Phone:347-417-1044
Mailing Address - Fax:
Practice Address - Street 1:1140 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1805
Practice Address - Country:US
Practice Address - Phone:517-364-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY04383208G00000X
MI5101025624208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)