=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598749178
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIKHAIL LOSIF AZRILEVICH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2005
-----------------------------------------------------
Last Update Date | 07/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9892 BUSTLETON AVE STE 101
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19115-2138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-676-2741
-----------------------------------------------------
Fax | 215-676-2796
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3500 N BROAD ST RM 1A
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19140-4106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-926-9019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD062068L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------