Healthcare Provider Details

I. General information

NPI: 1922445626
Provider Name (Legal Business Name): KIRILL ZAKHAROV D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E MICHIGAN AVE
LANSING MI
48912-1805
US

IV. Provider business mailing address

4185 STILLBROOK LN
DEWITT MI
48820-7889
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5200
  • Fax:
Mailing address:
  • Phone: 347-417-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number04383
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number5101025624
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: