Provider Demographics
NPI:1669408167
Name:DEPUTAT, MIKHAIL (MD)
Entity type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:
Last Name:DEPUTAT
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 1:150 SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5178
Mailing Address - Country:US
Mailing Address - Phone:352-867-8311
Mailing Address - Fax:352-867-1053
Practice Address - Street 1:1500 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6504
Practice Address - Country:US
Practice Address - Phone:352-867-8311
Practice Address - Fax:352-622-5771
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86601207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266236100Medicaid
FL62974OtherBCBS FL
FL62974VMedicare PIN
FLH69012Medicare UPIN
FL62974WMedicare PIN
FL62974OtherBCBS FL
FL62974ZMedicare PIN
FL62974UMedicare PIN
FLP00269533Medicare PIN