Provider Demographics
NPI:1033471834
Name:NIKOLAENKO, DMITRI (DO, MS)
Entity type:Individual
Prefix:DR
First Name:DMITRI
Middle Name:
Last Name:NIKOLAENKO
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 W 32ND ST UNIT 400
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1915
Mailing Address - Country:US
Mailing Address - Phone:512-454-5171
Mailing Address - Fax:512-454-0704
Practice Address - Street 1:1004 W 32ND ST UNIT 400
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1915
Practice Address - Country:US
Practice Address - Phone:512-454-5171
Practice Address - Fax:512-454-0704
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS0958207R00000X
CA20A15066207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty