Healthcare Provider Details

I. General information

NPI: 1053430157
Provider Name (Legal Business Name): ILIYA KHRAMOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W PLYMOUTH AVE
DELAND FL
32720-3236
US

IV. Provider business mailing address

1201 NW 16TH ST C114
MIAMI FL
33125-1624
US

V. Phone/Fax

Practice location:
  • Phone: 386-943-3160
  • Fax: 317-705-5047
Mailing address:
  • Phone: 786-217-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME101063
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME101063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: