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General NPI Number Information
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NPI Number | 1528208410
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Entity Type | Individual
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Provider Name | IVAN ATANASSOV MANIKATOV CSA
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Gender | Male
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Dates
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Enumeration Date | 03/05/2009
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 520 PEACOCK CT
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City | NAPERVILLE
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State | IL
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Zip | 60565-4164
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Country | US
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Telephone | 630-544-8473
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Fax | 630-357-2464
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Provider Business Mailing Address
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Address Line | 520 PEACOCK CT
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City | NAPERVILLE
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State | IL
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Zip | 60565-4164
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Country | US
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Telephone | 630-544-8473
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Fax | 630-357-2464
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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