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General NPI Number Information
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NPI Number | 1518699230
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Entity Type | Individual
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Provider Name | MAKSIM ILICH PUKHALSKIY DPM
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Gender | Male
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 3870 ROSIN CT
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City | SACRAMENTO
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State | CA
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Zip | 95834-1620
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Country | US
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Telephone | 916-923-8490
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Fax |
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Provider Business Mailing Address
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Address Line | 3713 SCALLOP CT
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City | NORTH HIGHLANDS
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State | CA
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Zip | 95660-5213
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Country | US
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Telephone | 916-923-8490
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E6149
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License Number State | CA
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