Provider Demographics
NPI:1699970491
Name:STRUT, MIKHAIL (MD)
Entity type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:
Last Name:STRUT
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 1:2560 WALDEN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4757
Mailing Address - Country:US
Mailing Address - Phone:716-681-4088
Mailing Address - Fax:716-681-4240
Practice Address - Street 1:2560 WALDEN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4757
Practice Address - Country:US
Practice Address - Phone:716-681-4088
Practice Address - Fax:716-681-4240
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239227208100000X
NY251108208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1699970491Medicaid
WV3810009612Medicaid
VAMC10218Medicare PIN
VA351477OtherANTHEM BCBS
MD0179256 00Medicaid
VA304897OtherANTHEM
VA014304W68Medicare PIN