Individual
KONSTANTIN Y MIKHAILOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
575 WEST RIVER WOODS PARKWAY, GLENDALE, WI 53212
(414) 961-6700
(414) 961-6727
Mailing address
4555 WEST SCHROEDER DRIVE, SUITE 170, MILWAUKEE, WI 53223
(414) 365-3210
(414) 365-3225
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
42850
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34122600
—
WI
Enumeration date
05/31/2006
Last updated
03/27/2008
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