Healthcare Provider Details

I. General information

NPI: 1518699230
Provider Name (Legal Business Name): MAKSIM ILICH PUKHALSKIY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 ROSIN CT
SACRAMENTO CA
95834-1620
US

IV. Provider business mailing address

3713 SCALLOP CT
NORTH HIGHLANDS CA
95660-5213
US

V. Phone/Fax

Practice location:
  • Phone: 916-923-8490
  • Fax:
Mailing address:
  • Phone: 916-923-8490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE6149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: