Khodarkovskiy, Mikhail
Khodarkovskiy, Mikhail is an individual health care provider with primary practice located at 333 E Il Route 83 Ste 105 , Mundelein IL 60060-4278. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Khodarkovskiy, Mikhail can be contacted via phone (847) 970-9922.Contact Information
Primary practice address
333 E Il Route 83 Ste 105
Mundelein IL 60060-4278
Phone: (847) 970-9922
Fax: (847) 970-9955
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 036-107538 | Illinois |
Profile Details
| NPI number | 1215919196 |
|---|---|
| LBN Legal business name | Khodarkovskiy, Mikhail |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 16th, 2005 |
| Last updated | Aug 12th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1215919196 | NPPES |
| Illinois | MEDICAID | 036-107538-4 |
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