Healthcare Provider Details

I. General information

NPI: 1326102088
Provider Name (Legal Business Name): SERGEI G BOIKOV PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19991 HALL RD STE 102
MACOMB MI
48044-4254
US

IV. Provider business mailing address

19991 HALL RD STE 102
MACOMB MI
48044-4254
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-4401
  • Fax: 586-263-4402
Mailing address:
  • Phone: 586-263-4401
  • Fax: 586-263-4402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000211
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: