Provider Demographics
NPI:1841351061
Name:MIKALOV, ABRAHAM (MD)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:
Last Name:MIKALOV
Suffix:
Gender:
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:PO BOX 9664
Mailing Address - Street 2:
Mailing Address - City:BEXLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43209-0664
Mailing Address - Country:US
Mailing Address - Phone:614-367-1234
Mailing Address - Fax:614-367-1233
Practice Address - Street 1:6100 E MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-3399
Practice Address - Country:US
Practice Address - Phone:614-367-1234
Practice Address - Fax:614-367-1233
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057674208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0837009Medicaid
OH0232221Medicaid
OH0837009Medicaid