Provider Demographics
NPI:1215128194
Name:TIHONOV, NIKITA Y (MD)
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:Y
Last Name:TIHONOV
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 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0735
Mailing Address - Country:US
Mailing Address - Phone:409-772-6366
Mailing Address - Fax:409-747-0999
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0735
Practice Address - Country:US
Practice Address - Phone:409-772-6366
Practice Address - Fax:409-747-0999
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1336962086S0129X
NHLT-36002086S0129X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHP01594542OtherRAILROAD MEDICARE
NHP01594542OtherRAILROAD MEDICARE