Basic Information
| Provider Information | |||||||||
| NPI: | 1669408167 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEPUTAT | ||||||||
| FirstName: | MIKHAIL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 SE 17TH ST | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344715178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3528678311 | ||||||||
| FaxNumber: | 3528671053 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 SW 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344716504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3528678311 | ||||||||
| FaxNumber: | 3526225771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 03/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME86601 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 266236100 | 05 | FL | MEDICAID | 62974 | 01 | FL | BCBS FL | OTHER |