Provider Demographics
NPI:1962849216
Name:KOSHELEV, MISHA VLADISLAVOVICH (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MISHA
Middle Name:VLADISLAVOVICH
Last Name:KOSHELEV
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:MIKHAIL
Other - Middle Name:VLADISLAVOVICH
Other - Last Name:KOSHELEV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 301173
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75303-1173
Mailing Address - Country:US
Mailing Address - Phone:713-500-8260
Mailing Address - Fax:
Practice Address - Street 1:6500 WEST LOOP S STE 200A
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3535
Practice Address - Country:US
Practice Address - Phone:713-500-8260
Practice Address - Fax:713-524-3432
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1398207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology