Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | MD484898 | PA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | MD484898 | PA |
N | 2081P2900X | Pain Medicine | 250059 | NY |
N | 2081P2900X | Pain Medicine | MD484898 | PA |
Y | 2081P2900X | Pain Medicine | ME100837 | FL |
NPI | 1033173471 |
---|---|
Provider Name | Dr. Mikhail J Artamonov |
First Address | East Stroudsburg, PA 18301-9101 |
Second Address | Sciota, PA 18354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 14/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03079009 | (05) | NY |
1011567330001 | (05) | PA |
I18217 | (02) | PA |