Healthcare Provider Details

I. General information

NPI: 1861572364
Provider Name (Legal Business Name): NYKOLAI VASIL PIDHORODECKYJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/25/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15251 PLEASANT VALLEY RD # RE-16
CENTER CITY MN
55012-9640
US

IV. Provider business mailing address

4280 COBBLESTONE DR
COPLEY OH
44321-2926
US

V. Phone/Fax

Practice location:
  • Phone: 651-213-4086
  • Fax: 330-606-5514
Mailing address:
  • Phone: 330-606-5514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number35-079642
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: