Healthcare Provider Details

I. General information

NPI: 1659908473
Provider Name (Legal Business Name): MAYYA VOLODARSKAYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E MILESTONE DR
APPLETON WI
54913-6701
US

IV. Provider business mailing address

2115 W CRYSTAL ST APT 2
CHICAGO IL
60622-7896
US

V. Phone/Fax

Practice location:
  • Phone: 920-731-8131
  • Fax:
Mailing address:
  • Phone: 312-942-5474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number87631-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301514904
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125.076024
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: