Provider Demographics
NPI:1306296447
Name:DOCTORS ON THE GO1 L.C
Entity type:Organization
Organization Name:DOCTORS ON THE GO1 L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-216-0838
Mailing Address - Street 1:1515 N WARSON RD
Mailing Address - Street 2:249
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-1111
Mailing Address - Country:US
Mailing Address - Phone:314-925-7595
Mailing Address - Fax:
Practice Address - Street 1:1515 N WARSON RD
Practice Address - Street 2:249
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-1111
Practice Address - Country:US
Practice Address - Phone:314-925-7595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty