Provider Demographics
NPI:1184807166
Name:LEZHAK, MIKHAIL (RPAC)
Entity type:Individual
Prefix:MR
First Name:MIKHAIL
Middle Name:
Last Name:LEZHAK
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12109 COUNTY ROAD 103
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2951
Mailing Address - Country:US
Mailing Address - Phone:352-205-8981
Mailing Address - Fax:
Practice Address - Street 1:545 HEALTH BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1493
Practice Address - Country:US
Practice Address - Phone:386-239-8540
Practice Address - Fax:386-248-8224
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2021-02-11
Deactivation Date:2008-02-26
Deactivation Code:
Reactivation Date:2008-03-18
Provider Licenses
StateLicense IDTaxonomies
FLPA9107273363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010231400Medicaid
GA003141591AMedicaid
FLP01574174Medicare PIN
GA003141591AMedicaid