Healthcare Provider Details

I. General information

NPI: 1730006974
Provider Name (Legal Business Name): JOHN MIKHAEIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE DEPARTMENT OF ANESTHESIA
BOSTON MA
02215
US

IV. Provider business mailing address

330 BROOKLINE AVE DEPARTMENT OF ANESTHESIA
BOSTON MA
02215
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-5048
  • Fax: 617-754-8791
Mailing address:
  • Phone: 617-667-5048
  • Fax: 617-754-8791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3019768
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: