Healthcare Provider Details

I. General information

NPI: 1851811434
Provider Name (Legal Business Name): NICOLAI ZHIDKOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 HOSPITAL DR
HANNIBAL MO
63401-6887
US

IV. Provider business mailing address

1005 BROADWAY ST
QUINCY IL
62301-2834
US

V. Phone/Fax

Practice location:
  • Phone: 573-248-5259
  • Fax:
Mailing address:
  • Phone: 217-223-8400
  • Fax: 217-223-8400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036162917
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036162917
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: