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NPI Code Detail

MEDICARE: MIKHAIL NIKOLAENKO 33.021612 N-R

MEDICARE: MIKHAIL NIKOLAENKO 33.021612 N-R
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
1225700000XMassage Therapist33.021612 N-ROH

General Provider Information

NPI Number : 1790186773
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKHAIL NIKOLAENKO 33.021612 N-R
Provider Business Mailing Address
First Line : 6398 LIBERTY FAIRFIELD RD
Second Line :
City : LIBERTY TWP
State : OH
Zip : 45011-5117
Country : US
Telephone Number : 513-907-6725
Fax Number :
Provider Business Practice Location Address
First Line : 11923 MONTGOMERY RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45249-2019
Country : US
Telephone Number : 513-907-6725
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2014
Last Update Date : 09/10/2014

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Directions to “ MIKHAIL NIKOLAENKO 33.021612 N-R” Practice Location

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