Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MD058411L | PA |
NPI | 1003853219 |
---|---|
Provider Name | Mikhail Freylikh |
First Address | Holland, PA 18966-5304 |
Second Address | Philadelphia, PA 19116-2107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 02/07/2010 |