Individual
MIKHAIL NOVIKOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
318 MAIN ST STE 165, NORTHBOROUGH, MA 01532-3609
(508) 936-1657
Mailing address
10 THADDEUS MASON RD, NORTHBOROUGH, MA 01532-2284
(617) 209-7823
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
241998
MA
208600000X
Surgery Physician
Primary
241998
MA
208D00000X
General Practice Physician
241998
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110086646A
—
MA
01
—
P00838801
RAILROAD MEDICARE
MA
Enumeration date
07/20/2007
Last updated
05/31/2019
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