Healthcare Provider Details

I. General information

NPI: 1093872822
Provider Name (Legal Business Name): MICHAEL NIKOLOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 N RANDALL RD DEPT OF
ELGIN IL
60123-2300
US

IV. Provider business mailing address

9135 LAKESHORE DIVE
PLEASANT PRAIREI WI
53158
US

V. Phone/Fax

Practice location:
  • Phone: 847-742-9800
  • Fax:
Mailing address:
  • Phone: 708-275-3703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number84181-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036092238
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME155769
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: