Basic Information
| Provider Information | |||||||||
| NPI: | 1700868742 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIKHAIL | ||||||||
| FirstName: | ATTEF | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 932163 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441930001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864124000 | ||||||||
| FaxNumber: | 5864124100 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MEDICAL VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | EDGEWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410173403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593012160 | ||||||||
| FaxNumber: | 8593013932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 08/07/2013 | ||||||||
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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 | 2085R0202X | 38677 | IA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 30286 | KY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 38677 | IA | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 174400000X | 30286 | KY | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | P00863651 | 01 | KY | MEDICARE PTAN | OTHER | 2700509 | 05 | OH | MEDICAID | 300048821 | 01 | RRMC | OTHER | 64302862 | 05 | KY | MEDICAID |