Individual
DR. ILYA FATAKHOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 HOSPITAL PLZ DEPT OF, STAMFORD, CT 06902-3602
(203) 276-7298
(203) 276-4842
Mailing address
1 HOSPITAL PLZ DEPT OF, STAMFORD, CT 06902-3602
(203) 276-7147
(203) 276-7368
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
56588
CT
Other
Enumeration date
04/17/2014
Last updated
07/29/2019
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