Healthcare Provider Details

I. General information

NPI: 1144395849
Provider Name (Legal Business Name): DANAIL VATEV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7035 W GRAND AVE
CHICAGO IL
60707-2143
US

IV. Provider business mailing address

7035 W GRAND AVE
CHICAGO IL
60707-2143
US

V. Phone/Fax

Practice location:
  • Phone: 773-385-8031
  • Fax: 773-385-8035
Mailing address:
  • Phone: 773-385-8031
  • Fax: 773-385-8035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036091320
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: