Healthcare Provider Details

I. General information

NPI: 1801192703
Provider Name (Legal Business Name): ILYA TIKHONOV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 NEW LEICESTER HWY UNIT G
ASHEVILLE NC
28806-1512
US

IV. Provider business mailing address

353 NEW LEICESTER HWY STE G
ASHEVILLE NC
28806-2058
US

V. Phone/Fax

Practice location:
  • Phone: 855-993-0990
  • Fax: 828-232-9969
Mailing address:
  • Phone: 855-993-0990
  • Fax: 828-232-9969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: