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NPI Code Detail

MEDICARE: MIKHAIL VASSILENKO MD

MEDICARE: MIKHAIL VASSILENKO MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianMD062001LPA
22084P0800XPsychiatry PhysicianME156021FL

General Provider Information

NPI Number : 1053380584
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKHAIL VASSILENKO MD
Provider Business Mailing Address
First Line : 1065 NE 125TH ST STE 300
Second Line :
City : NORTH MIAMI
State : FL
Zip : 33161-5833
Country : US
Telephone Number : 786-221-0908
Fax Number : 305-891-4228
Provider Business Practice Location Address
First Line : 10301 HAGEN RANCH RD STE B200
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33437-3723
Country : US
Telephone Number : 561-752-9490
Fax Number : 561-752-9491
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2006
Last Update Date : 01/16/2024

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Directions to “ MIKHAIL VASSILENKO MD” Practice Location

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