Provider Demographics
NPI:1679766034
Name:PRYKHODKO, MYKOLA O (MD)
Entity type:Individual
Prefix:
First Name:MYKOLA
Middle Name:O
Last Name:PRYKHODKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:614-544-6155
Mailing Address - Fax:
Practice Address - Street 1:770 BALGREEN DR
Practice Address - Street 2:SUITE 209
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-4106
Practice Address - Country:US
Practice Address - Phone:419-756-5500
Practice Address - Fax:419-756-5502
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.097400207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH018691Medicare PIN