Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 24133 | NE |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 24133 | NE |
N | 208200000X | Surgeon | 24133 | NE |
N | 208600000X | Surgeon | 24133 | NE |
N | 2086X0206X | Surgical Oncologist | 24133 | NE |
NPI | 1306879291 |
---|---|
Provider Name | Oleg N. Militsakh |
First Address | Virginia Beach, VA 23450-0190 |
Second Address | Omaha, NE 68114-4108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 16/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025044400 | (05) | NE |
1306879291 | (05) | IA |
1306879291 | (05) | MO |