Provider Demographics
NPI:1386075406
Name:MEDVEDOVSKI, DMITRI MIKHAYLOVICH (PHD)
Entity type:Individual
Prefix:DR
First Name:DMITRI
Middle Name:MIKHAYLOVICH
Last Name:MEDVEDOVSKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 BETHEL DR # 10
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6902
Mailing Address - Country:US
Mailing Address - Phone:651-638-6566
Mailing Address - Fax:
Practice Address - Street 1:3900 BETHEL DR # 10
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-6902
Practice Address - Country:US
Practice Address - Phone:651-638-6566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-30
Last Update Date:2013-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator