Individual
MR. MIKHAIL ILIATOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
6802 RIDGE BLVD APT 3B, BROOKLYN, NY 11220-5817
(347) 724-3435
Mailing address
6802 RIDGE BLVD APT 3B, BROOKLYN, NY 11220-5817
(347) 724-3435
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F312747-01
NY
Other
Enumeration date
05/14/2026
Last updated
05/14/2026
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