Provider Demographics
NPI:1952391955
Name:GEYER, MIKHAIL WOLF (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:WOLF
Last Name:GEYER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6202 S HALSTED ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-2029
Mailing Address - Country:US
Mailing Address - Phone:847-259-7482
Mailing Address - Fax:847-258-7494
Practice Address - Street 1:1770 W HINTZ RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-5281
Practice Address - Country:US
Practice Address - Phone:847-259-7482
Practice Address - Fax:847-258-7494
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-023529122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist