MEDICARE: DR. MICHAEL YURYEV DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	254873	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A400073006	OTHER	NY	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174857817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL YURYEV DO

Provider Business Mailing Address
First Line	:	2409 OCEAN AVE UNIT 1F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3576
Country	:	US
Telephone Number	:	718-444-7774
Fax Number	:	718-444-7775

Provider Business Practice Location Address
First Line	:	2409 OCEAN AVE
Second Line	:	UNIT # 1F
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3564
Country	:	US
Telephone Number	:	718-444-7774
Fax Number	:	718-444-7775

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2009
Last Update Date	:	09/18/2018

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