MEDICARE: MIKHAIL LOSIF AZRILEVICH 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
1	207R00000X	Internal Medicine Physician	MD062068L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
12	110150740	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0131367000	OTHER	PA	INDEPENDENCE BLUE CROSS
3	2871	OTHER	PA	BRAVO HEALTH
4	546193	OTHER	PA	COVENTRY HEALTH AMERICA
5	P945996	OTHER	PA	OXFORD
6	117016	OTHER	PA	HIGHMARK BLUE SHIELD
7	2Y3072	OTHER	PA	HEALTH NET
8	30033849	OTHER	PA	KEYSTONE MERCY HEALTH PLA
9	0866629	OTHER	PA	AETNA HMO
10	5615579	OTHER	PA	AETNA PPO
11	0166313302	OTHER	PA	AMERICHOICE

General Provider Information

NPI Number	:	1598749178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKHAIL LOSIF AZRILEVICH MD

Provider Business Mailing Address
First Line	:	3500 N BROAD ST RM 1A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-4106
Country	:	US
Telephone Number	:	215-926-9019
Fax Number	:

Provider Business Practice Location Address
First Line	:	9892 BUSTLETON AVE STE 101
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-2138
Country	:	US
Telephone Number	:	215-676-2741
Fax Number	:	215-676-2796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	07/18/2025

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