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General NPI Number Information
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NPI Number | 1003847237
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Entity Type | Individual
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Provider Name | IRINA KOSTOVA DIMITROVA M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 2350 N LAKE DR
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City | MILWAUKEE
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State | WI
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Zip | 53211-4528
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Country | US
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Telephone | 414-585-1949
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Fax |
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Provider Business Mailing Address
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Address Line | 400 W RIVER WOODS PKWY
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City | GLENDALE
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State | WI
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Zip | 53212-1060
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 01088502A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4301080622
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 44128
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD60306703
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | DR.0044128
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License Number State | CO
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Taxonomy #6
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | MD209404
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License Number State | OR
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Taxonomy #7
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 4301080622
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License Number State | MI
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Taxonomy #8
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | MD479477
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License Number State | PA
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