MEDICARE: MIKHAIL ABRAMOVICH FUKS M.D.

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	207Q00000X	Family Medicine Physician	207032	NY

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

General Provider Information

NPI Number	:	1770579062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKHAIL ABRAMOVICH FUKS M.D.

Provider Business Mailing Address
First Line	:	150 BROADWAY
Second Line	:	SUITE 714
City	:	NEW YORK
State	:	NY
Zip	:	10038-4381
Country	:	US
Telephone Number	:	212-964-5555
Fax Number	:	212-964-0474

Provider Business Practice Location Address
First Line	:	150 BROADWAY
Second Line	:	SUITE 714
City	:	NEW YORK
State	:	NY
Zip	:	10038-4381
Country	:	US
Telephone Number	:	212-964-5555
Fax Number	:	212-964-0474

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	07/02/2009

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