Konstantin Y Mikhailov, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

42850 Issued in WI

Practice address

575 West River Woods Parkway
Glendale, WI 53212

Phone

(414) 961-6700

Fax

(414) 961-6727

NPI assigned

May 31, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Great Lakes Anesthesia and Pain Specialists SC

  • Anesthesiology Physician
  • Franklin, WI
  • NPI 1720218647
  Medicare reassignment NPD
• Orthopaedic Hospital of Wisconsin, LLC

  • General Acute Care Hospital
  • Glendale, WI
  • NPI 1669584983
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206576000000",
    "number": "1881641074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4555 WEST SCHROEDER DRIVE",
            "address_2": "SUITE 170",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53223",
            "telephone_number": "414-365-3210",
            "fax_number": "414-365-3225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 WEST RIVER WOODS PARKWAY",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "53212",
            "telephone_number": "414-961-6700",
            "fax_number": "414-961-6727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKHAILOV",
        "first_name": "KONSTANTIN",
        "middle_name": "Y",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2008-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WI",
            "license": "42850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34122600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Austin Hugh Middleton, MD
• Donald Kevin Middleton, MD
• Midwest Dialysis Center, Inc
• Midwest Interventional Pain and Diagnostics
• Midwest Spine Center SC
• Marisa K Miller
• Milwaukee Family Chiropractic
• Milwaukee Occupational Medicine SC
• Catherine C Mingo, MD
• Miracle Beginnings LLC

• Anesthesiology Physician in Glendale, WI
• Providers in Glendale, WI by specialty
• Anesthesiology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.