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NPI Code Detail

MEDICARE: DR. DMITRIY M PELISHEV D.O.

MEDICARE: DR. DMITRIY M PELISHEV D.O.
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
1207Q00000XFamily Medicine Physician062154GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457400251
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DMITRIY M PELISHEV D.O.
Provider Business Mailing Address
First Line : PO BOX 740015
Second Line :
City : ATLANTA
State : GA
Zip : 30374-0015
Country : US
Telephone Number : 312-773-9730
Fax Number :
Provider Business Practice Location Address
First Line : 3088 WASHINGTON RD
Second Line :
City : EAST POINT
State : GA
Zip : 30344-4566
Country : US
Telephone Number : 470-444-3135
Fax Number : 404-777-9336
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2007
Last Update Date : 08/16/2023

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