MEDICARE: ELEINA MIKHAYLOV 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	2084N0400X	Neurology Physician	1792788	MI
2	2084N0400X	Neurology Physician	35.099772	OH

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	:	1790984045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEINA MIKHAYLOV MD

Provider Business Mailing Address
First Line	:	6599 WOODBANK DR
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-3036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 MIAMI VALLEY DR
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4774
Country	:	US
Telephone Number	:	937-208-4200
Fax Number	:	937-208-2678

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

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	10/29/2018

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