Provider Demographics
NPI:1881697142
Name:KAZIMIRKO, NICOLAY N (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLAY
Middle Name:N
Last Name:KAZIMIRKO
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:L-3396
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-3396
Mailing Address - Country:US
Mailing Address - Phone:740-615-1324
Mailing Address - Fax:740-615-1344
Practice Address - Street 1:561 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1410
Practice Address - Country:US
Practice Address - Phone:740-615-1324
Practice Address - Fax:740-615-1344
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH81544207L00000X
IN01055180A207L00000X
OH35.081544207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2707416Medicaid
OH2707416Medicaid
H81789Medicare UPIN