Healthcare Provider Details

I. General information

NPI: 1780846444
Provider Name (Legal Business Name): DMITRI KOLYCHEV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3378 W. MARKET ST SUITE A
FAIRLAWN OH
44333
US

IV. Provider business mailing address

3378 W MARKET ST STE A
FAIRLAWN OH
44333-3306
US

V. Phone/Fax

Practice location:
  • Phone: 330-576-3500
  • Fax: 234-312-2405
Mailing address:
  • Phone: 330-576-3500
  • Fax: 234-312-2405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35.137174
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number35.137174
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: