Provider Demographics
NPI:1780724591
Name:KHILKIN, MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KHILKIN
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 1:245 E 19TH ST
Mailing Address - Street 2:APT. 6T
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2639
Mailing Address - Country:US
Mailing Address - Phone:917-885-5360
Mailing Address - Fax:
Practice Address - Street 1:245 E 19TH ST
Practice Address - Street 2:APT. 6T
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2639
Practice Address - Country:US
Practice Address - Phone:917-885-5360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232613207RC0200X, 207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine