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NPI Code Detail

MEDICARE: DR. MICHAEL TYSHKOV MD

MEDICARE: DR. MICHAEL TYSHKOV MD
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
12080P0206XPediatric Gastroenterology Physician180877NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902882038
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL TYSHKOV MD
Provider Business Mailing Address
First Line : 1 EDGEWATER ST
Second Line : 6TH FL. PAYER RELATIONS
City : STATEN ISLAND
State : NY
Zip : 10305-4900
Country : US
Telephone Number : 718-226-1008
Fax Number : 718-226-1039
Provider Business Practice Location Address
First Line : 584 FOREST AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10310-2512
Country : US
Telephone Number : 718-226-5619
Fax Number : 718-226-5620
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2005
Last Update Date : 12/31/2008

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