Healthcare Provider Details

I. General information

NPI: 1720277387
Provider Name (Legal Business Name): NIKOLAY G DELEV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W WELLINGTON AVE ROOM 7304
CHICAGO IL
60657-5193
US

IV. Provider business mailing address

856 W NELSON ST. # 503
CHICAGO IL
60657-5101
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-7046
  • Fax:
Mailing address:
  • Phone: 571-331-0899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: