Healthcare Provider Details

I. General information

NPI: 1881273480
Provider Name (Legal Business Name): MAHIR GACHABAYOV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODS RD
VALHALLA NY
10595-1530
US

IV. Provider business mailing address

16001 W 9 MILE RD FL 5
SOUTHFIELD MI
48075-4818
US

V. Phone/Fax

Practice location:
  • Phone: 917-500-0161
  • Fax:
Mailing address:
  • Phone: 586-226-6120
  • Fax: 586-226-6123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number4301517897
License Number StateMI
# 2
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: