Provider Demographics
NPI:1578023784
Name:MICHAEL YERUKHIM, MD LLC
Entity type:Organization
Organization Name:MICHAEL YERUKHIM, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAVONNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:URBAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, MS ED, NCC
Authorized Official - Phone:216-798-3299
Mailing Address - Street 1:7215 OLD OAK BLVD STE A414
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3377
Mailing Address - Country:US
Mailing Address - Phone:440-816-2776
Mailing Address - Fax:440-816-2709
Practice Address - Street 1:7215 OLD OAK BLVD STE A414
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3377
Practice Address - Country:US
Practice Address - Phone:440-816-2776
Practice Address - Fax:440-816-2709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0110500Medicaid