Provider Demographics
NPI:1740330414
Name:NIKOLAI KINACHTCHOUK,M.D. & LIOUDMILA KINACHTCHOUK,M.D. P.L.C.
Entity type:Organization
Organization Name:NIKOLAI KINACHTCHOUK,M.D. & LIOUDMILA KINACHTCHOUK,M.D. P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIOUDMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINACHTCHOUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-790-2958
Mailing Address - Street 1:4705 TOWNE CENTRE RD
Mailing Address - Street 2:STE 102
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2818
Mailing Address - Country:US
Mailing Address - Phone:989-790-2958
Mailing Address - Fax:989-790-2983
Practice Address - Street 1:4705 TOWNE CENTRE RD
Practice Address - Street 2:STE 102
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2818
Practice Address - Country:US
Practice Address - Phone:989-790-2958
Practice Address - Fax:989-790-2983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4564845Medicaid
MI4564845Medicaid
MIG325930Medicare UPIN