Healthcare Provider Details

I. General information

NPI: 1740930213
Provider Name (Legal Business Name): MIKHAIL GUREVICH MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 03/26/2022
Certification Date: 03/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK MEDICINE HSC T-18 DEPARTMENT OF ORTHOPAEDICS
STONY BROOK NY
11794-8181
US

IV. Provider business mailing address

101 NICOLLS RD
STONY BROOK NY
11794-8181
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-1487
  • Fax: 631-444-3502
Mailing address:
  • Phone: 631-444-1487
  • Fax: 631-444-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: