Healthcare Provider Details

I. General information

NPI: 1316158181
Provider Name (Legal Business Name): DR. CVETAN IVANOV MECHEV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 N ARLINGTON HEIGHTS RD STE 204
ARLINGTON HEIGHTS IL
60004-4825
US

IV. Provider business mailing address

8440 N OLEANDER AVE
NILES IL
60714-2054
US

V. Phone/Fax

Practice location:
  • Phone: 847-259-2461
  • Fax: 847-577-0150
Mailing address:
  • Phone: 773-203-4652
  • Fax: 847-577-0150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number62281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: