Provider Demographics
NPI:1932370731
Name:TAKHALOV, YURY (MD)
Entity Type:Individual
Prefix:DR
First Name:YURY
Middle Name:
Last Name:TAKHALOV
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:840 S. WOOD ST., SUITE 130 CSN
Mailing Address - Street 2:UNIVERSITY OF ILLINOIS AT CHICAGO
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-996-3879
Mailing Address - Fax:312-413-1436
Practice Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Practice Address - Street 2:DEPT OF PATHOLOGY HOS2
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-7025
Practice Address - Country:US
Practice Address - Phone:631-444-2224
Practice Address - Fax:631-444-3424
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2011-06-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY255706207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology