Provider Demographics
NPI:1598985186
Name:MIHAYLOV, TIHOMIR B (MD)
Entity type:Individual
Prefix:DR
First Name:TIHOMIR
Middle Name:B
Last Name:MIHAYLOV
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 1:20225 E 9 MILE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1775
Mailing Address - Country:US
Mailing Address - Phone:586-779-8700
Mailing Address - Fax:586-498-1425
Practice Address - Street 1:20225 E 9 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1775
Practice Address - Country:US
Practice Address - Phone:586-779-8700
Practice Address - Fax:586-498-1425
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E031610OtherBCBS GROUP NUMBER
MI5217979Medicaid
MI700E031610OtherBCBS GROUP NUMBER
MION67900003Medicare PIN
MIMI3996041Medicare PIN