# MIKHAIL V DOMNINE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1659453454
- **Gender:** Man
- **Credential:** PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 001001114 | NC | — |
| 363A00000X | Physician Assistant | C0009827 | MD | Yes |
| 363A00000X | Physician Assistant | MA052604 | PA | — |

## Other

- **Enumeration date:** 10/20/2006
- **Last updated:** 07/29/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 164XJ | BCBSNC | NC |
| 01 | — | 2687 | EVOLUTIONS HEALTHCARE SYSTEMS | NC |
| 01 | — | 7790899 | AETNA | NC |